Mid face volume loss after Hyaluronidase, 33 y/o - Would I benefit from blepharoplasty, mid or High SMAS facelift? (photos)

Question

I was grosely overfilled and then treated with hyaluronidase. I now have hollowness and bags/festoons under eyes. Im 33, non smoker, eat healthy and exersise 5 times a week. My concern is my midface and eyes. I have had heavyness in my upper eyes since 25. i use botox to lift them But now i cant put eyeliner on my wing anymore. Could i have a upper/lower blepheroplasty with midface lift? Or a High smas? I have alot of laxity after competing in fitness as well.

Thomas A. Mustoe, MD, FACS · Answer

An in person consultation Would be necessary to give you the best advice but you need more volume and possibly a midface lift.  Fat grafting skillfully done Would be helpful but probably need fat grafting more than once to achieve a natural and optimal result.

Alan Gonzalez, MD, FACS · Answer

Hello @Luminous844124, thank you for your question. I would suggest a lower blefaroplasty to get rid of the fat in the lower eyelids. I would encourage you to schedule a consultation with a board-certified plastic surgeon. During your consultation, your surgeon will be able to assess your unique needs and develop a treatment plan that is right for you. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS),International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Mansher Singh, MD, FACS · Answer

Hi generally speaking you would be in the younger side for a facelift. However, we have some facelifts on patients your age who have excess laxity due to genetic issues or weight fluctuations. You would benefit from being seeing in person by a plastic surgeon who does lots of face procedures.

Donald Groves, MD · Answer

Hello and thank you for your question. From what I can tell based on the pictures you have provided, you have great jawline definition without any jowling present. I do not see any fullness to your chin/submental region. Your neck skin appears tight and youthful without any visible platysmal banding in your neck. Based on all that, you would NOT benefit from any type of facelift at this time. 
Given the asymmetries in your midface, particularly the volume loss, I would recommend facial fat grafting. With age, the soft tissues of the face start to descend and we lose volume from fat atrophy and bone loss, resulting in the characteristic changes of facial aging. This volume loss is particularly notable in the midface/cheeks. In your case, given the filler which had then been dissolved, this is more asymmetric and noticeable. Fat grafting is perfect in your case for correcting the asymmetries and restoring volume to your cheeks and any other focal areas of concern- the fat is taken from your abdomen or thighs. Since this is your body's own natural tissue, you don't have to worry about rejection or reactions to the injected material. Once the fat "takes" (lives and integrates into the new injected site), the results last a long time. 
Regarding your eyes- it is difficult to see the bulging of the lower lids ("bags under eyes") that you mentioned from these pictures- they commonly occur with age though, and if present, you would be a good candidate for a lower lid blepharoplasty as well. The blepharoplasty can be done at the same time as the facial fat grafting.
With all that said, it is difficult to provide tentative surgical recommendations, since there is only so much information to be gained from these two photos- especially given the lighting and the scribbling covering the right lower lid in the second photo. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Derek Fletcher, MD · Answer

Unfortunately, I can't comment on you upper lids with your current photos. However, if you are correct in your upper eyelid assessment, combining upper lid blepharoplasty with transconjuntival (incision on the inside of the lid) lower eyelid blepharoplasty with facial micro fat grafting to restore volume to your tear trough and mid face is the most reliable operation. Without seeing your lower face, it is not possible to comment on whether a mid face lift or formal, high SMAS facelift is appropriate.

Suleyman Tas, MD, FEBOPRAS · Answer

Dear Luminous844124,

We have seen your pictures after which we can recommend you to get upper/lower blepheroplasty with midface lift which is a scarless procedure just as you have suggested. This procedure is scarless as i said because the scars will be hidden beneath the hairline. Moreover, the upper eyelid surgery will eliminate the excess skin and the lower blepheroplasty will eliminate the puffiness resulting in skin tightening.For a little more information regarding these procedures please visit the attached link.

Best Regards,
TAS TEAM

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. The skin laxity you’re referring to may be caused by volume loss which can be restored with either dermal filler injections or an autologous fat transfer. Hyaluronic acid dermal fillers can restore lost volume to areas of the face to provide a subtle lift. A facial fat transfer uses your body’s own fat to rebuild volume in the face. Fat transfer injections are a safe, natural, non-allergenic way to enhance the contour of the face and restore lost volume. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector who can assess your concerns and suggest the best course of action.

Ajaya Kashyap, MD · Answer

Thankyou for your question. You appear to be a little young for a full facelift, although you seem to have had a significant volume loss in the mid-face. If you do not wish to have fillers or autologous fat to restore the volume, a mid face lift using a limited incision beneath extending to the side of the lower eyelid will provide an adequate lift and also improve the lower eyelid through the same incision. Please find an experienced Board certified Plastic surgeon who is experienced in the procedure and have all your concerned answered after a careful examination, before planning on procedure. All the best!

Kerem Sami Kaya, MD · Answer

Actually, it may not correct to analysis these problems only with the front view photos taken by telephone camera. But I think you are a good candidate for lower blepharoplasty surgery. But your complaints about your cheek or malar zone may not solve with lower blepharoplasty surgery. So, İf there is insufficiency in the cheeks area, it will be solved with a little (very little for natural look) fat injection. Also, I think that any facelift technique is not necessary for you. It is important that you could manage the process with a competent surgeon.Have a nice day.

Ronald J. Edelson, MD · Answer

Don’t overthink this. You don’t need a facelift of any kind. Just get your upper and lower lids done in a very standard fashion. And no fat injections around the eye either. If anyone recommends that you’re in the wrong place

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