Fixing Under Eye Wrinkles with Blepharoplasty? (photos)

I was born with wrinkles underneath of my eye and hollowness as well. This is very unattractive to me and has always made me very self conscience. I'm 21 and I want it fixed. I want a normal under eye area. My eyes have always aged me. I was wondering if I should go with lower blepharoplasty to fix the wrinkles and hollowness/crease of fatty extra skin right by my nose? I was also wondering what are any other options that might be beneficial to fixing my under eye problems? Thanks!

Doctor Answers 27

From your photos, it does not seems as though a blepharoplasty would be the answer.

From your photos, it does not seems as though a blepharoplasty would be the answer. You do have significant hollows under your eyes, which is caused by a lack of volume. In someone your age, the best way to treat this concern is most likely with hyaluronic acid dermal fillers such as Restylane. These fillers add volume and can produce wonderful results under the eyes. See a board-certified facial plastic surgeon for a consultation. I hope this helps.

Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Volume is your answer

I'd say there's more an issue of a lack of volume in your orbital rim and tear trough area. I would suggest Restylane first or another type of HA filler. The next thing about these materials is that they are reversible with an enzyme if you don't like it. Fat transfer is also an option. Surgical intervention I don't see as being a good option for you and I love to do I surgery. Good luck

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

Under Eye Hollows, Dark Circles, and Crinkles Respond Well Nonsurgically To Fillers & Neuromodulators

The presence of hollows, dark circles and crinkles under the eyes can be quite distressing.
Not all that long ago, these problems were very difficulty to treat and surgery was the only option. However, surgical interventions to stretch the skin in the area, which were good for fine wrinkles and crinkles, often achieved the opposite effect by accentuating the hollows and shadowing.

Some fairly recent medical revelations have led to a radical shift in our approach. Physicians discovered that the hollows resulted largely from loss of fat volume in the area below the eyes due to shrinkage and gravitational sinking, or, as in this case, genetic or constitutional factors. They also discovered that either in large or part measure,  dark circles resulted from the fact that after the loss of the fat pad, the thin, delicate skin of the lower lid began to reflect the dark color of the small blood vessels and the muscles of facial expression immediately beneath it. These findings led to nonsurgical under eye rejuvenation.

By instilling a filler (I Belotero Balance, since it flows smoothly under the thin eyelid skin and has little risk of causing a bluish discoloration of the skin known as the Tyndal Effect), you can restore the lost volume to raise the hollow and also brighten the darkness by placing the filler between the dark structures below and the skin. Combining a tiny amount of Radiesse, a whitish colored injectable, with the Belotero can yield additional lightening, if desired.

The technique usually takes no more than five minutes per lower eyelid and is relatively painless, since the filler is combined with a local anesthetic. The procedure is one of a number of nonsurgical techniques that usually elicits a "Wow!" from patients the minute they see themselves in the mirror immediately afterward.

When crinkles are present, particularly in a younger person where skin elasticity is generally adequarte, instilling a microdroplet of a neuromodulator, such as Botox, Dysport or Xeomin, can be quite helpfull for smoothing this region. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Eyelid area can respond well to non-surgical treatments

For someone your age, you can certainly get some great results without surgery and I would think surgery should be avoided at this time. Botox can relax the crinkle lines that come from smiling. A dermal filler such as Restylane or belotero can be used to fill the hollows. Eye creams are particularly helpful for the fine lines but lasers can be used as well. Skin tightening devices such as Pelleve radiofrequency device can be used to tighten the skin with no downtime. I think you would get the most benefit from filling the hollows.

Elizabeth F. Rostan, MD
Charlotte Dermatologist
4.2 out of 5 stars 19 reviews

Severe tear trough abnormality treated with fillers.

In the photograph it appears as though there is a sizable volume deficiency around the orbit. To start with, fillers can be used to test the aesthetic benefit.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Hollowness under the eyes can make you look tired, filler can help

Treating the under-eyes with filler such as Restylane or Belotero can help soften eye bags and hollow under eyes. For over-active muscles, lines can be softened with Botox. For older patients, wrinkles are best softened by fractionated laser treatments.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 125 reviews

Fillers, not surgery, at this time

Consider lower eyelid fillers, which are safe, effective and natural. Lower blepharoplasty is not for you at this time. See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Eyelid Surgery for Hollows?

My first recommendation is that you should do some research and locate a board certified plastic surgeon or facial plastic surgeon with extensive experience with blepharoplasty and other methods of fine tuning the eye area.  Since you are so young, you may need to find a surgeon you can work with over a period of time to find solutions together.

Blepharoplasty of the lower lids usually involves removing fat, and that is not the answer in your case.  In fact, it appears that you would benefit from adding a dermal filler or transferring fat to the area under your eyes to minimize prominent hollows and lines.  That would be one of the least invasive steps to take.  If it doesn't seem to bring about enough of a change, it's possible that removing a small amount of skin under the eye would also help.

Without a personal exam it's difficult to make a solid recommendation, but it makes sense to start with a less invasive procedure and progress from there as required.  Consult a few skilled plastic surgeons and see what they have to say.  Ask if they have worked with young patients with deep set eyes like you have, and ask to see before and after photos.

Good luck,

Elliot Jacobs, M.D.

New York Plastic Surgeon

Elliot W. Jacobs, MD
New York Plastic Surgeon
4.4 out of 5 stars 34 reviews

Lower blepharoplasty is not for you

Lower blepharoplasty is not for you. It may even make you look worse. You need Restylane injection with a fine cannula (not a needle) and in little amount, in a deep plane. You may need it repeated every 5 to 6 months.

Nabil Fanous, MD
Montreal Facial Plastic Surgeon
4.2 out of 5 stars 6 reviews

Lower lid issues

An exam in person would be essential, but perhaps delicately palcing filler along the tear trough region may help your situation.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.