Will I Benefit from Under Eye Surgery? (photo)

I have extra skin and wrinkles on top of fat pads under my eyes. I'm still pretty young and I've tried so many things to help correct it. Botox causes excess swelling in my fat pads so I can't do that, I've had filler but didn't help much and I had a chemical peel to try to tighten and didn't help at all! I guess next step is surgery. Please help I need advice.

Doctor Answers 9

Your under eye wrinkles can be treated with a combination of non-surgical treatments.Fat under the eyes require surgical removal

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Puffiness under the eyes that doesn’t go away regardless of sleep, allergy and sinus management is basically a problem called lower eyelid fat prolapse. This occurs when the fat around the eyes pushes forward and becomes like a hernia. When fat prolapse is first manifested, you can get away with the use of fillers such as restylane or a hyaluronic acid-type of filler. Once you go beyond a certain threshold then you have no choice but to consider a surgical procedure. 

I routinely perform a procedure called transconjunctival blepharoplasty. This is a procedure where the fat pockets are sculpted behind the eyelid. The results look natural with no outside incision.

To deal with the lines under the eyes, I think you are a good candidate for a quick recovery type of procedure called fractional CO2 laser. This is applied to the skin and creates columns of thermal that stimulates the collagen. It also causes a contracting effect which tightens the skin.

In addition, we employ a cutting edge treatment called platelet-rich plasma. This is done by drawing your own blood, spinning it down and separating out the active healing component of the blood called the platelets. This stimulates better circulation and collagen to the skin that removes the static wrinkles under the eyes. I would probably supplement and maintain you with a treatment such as Botox or Dysport in order to minimize the activity of the muscle so that those wrinkles can be kept under control. I hope that was helpful, and thank you for question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Lower eyelid blepharoplasty and Botox injections - Los Angeles

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Lower eyelid surgery can resurface the lower eyelids and remove excess fat. Patients with dynamic wrinkles may also benefit from Botox or Xeomin injections. Raffy Karamanoukian 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Wrinkled, Saggy Lower Eyelid Skin treatment options

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Wrinkled, Saggy Lower Eyelid Skin treatment options
First I would address the reason for these lower lid  and crows-feet wrinkles. These type of wrinkles are often seen in patients that squint so first of all I would make sure that if you need visual correction then use glasses or contacts (if not sure, have your vision tested) and use sunglasses on bright days.                                                                                                                                                                                    Now for treatment options, other than the frequent use of moisturizers, Retinoids like Retin-A, and sunscreens you can consider the use of fillers like Restylane and Juvederm are helpful to decide the degree of benefit from supporting the skin. If you like the effect then consider a more permanent solution like fat transfer. Secondly, a deeper TCA peel, or fractional laser often helps. Both fillers and resurfacing procedures are complementary and synergistic in your case. For redundant skin, a conservative skin pinch blepharoplasty may also be of benefit. A qualified board certified aesthetic surgeon will help you find the right treatment for you

Possible under eye surgery

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I agree that you do not seem to have any issue with protruding fat under your eyes.  The main issue seems to be some excess skin.  If that is the case, it's possible that a laser resurfacing procedure could help and it's also possible that surgically removing some of the skin could help.  A consultation would be needed to determine your options and what might be the best course of action.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Volume can help but....

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Honestly, from the photos you have posted, your fat pads do not seem to be a significant problem for you. Mostly what we see here is eyelid/cheek skin wrinkling and creping.

It would be good to see photos without your smiling, but what you would most benefit from is periocular laser resurfacing. You are the perfect candidate from a skin color/tone perspective.

Obviously, an in-person evaluation would be needed to assess the lower eyelid tone and position because laser resurfacing can put you at risk at lower eyelid retraction.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Lower Eyelid Surgery for Wrinkles and Extra Skin

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It is difficult to assess the amount of excess lower lid fat or skin from the photo views provided. Generally, surgery only improves lower lid wrinkles if they are due to extra skin. If the lines are due to poor tissue elasticity and/or facial expression and Botox is not an option, I recommend trying Bellateri which can effectively treat eyelid wrinkles. Additionally, I would speak to your plastic surgeon about doing a deeper chemical that is suitable around the eyes. 

Anita Mandal, MD
Palm Beach Facial Plastic Surgeon

Will I Benefit from Under Eye Surgery? (photo)

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Hi Mktay and thanks for your question

You have 2 sets of wrinkles. One directly under the eye and the other one on the cheek bone. You get them on the cheek because you lose the underlying volume as you age. Think of a fresh prune versus a dried prune. When its fleshy part dries up and shrinks the skin is no longer tight but wrinkly. The muscle that is over this cheek bone can now produce deep folds as there is no 'fat' underneath it to keep it puffed up. So Botox addresses the muscle contraction but does not correct the loss in volume. You will benefit from injection of Filler, such as Voluma by Juvederm to the cheeks. You may need Botox but you can see the response and decide. The undereye wrinkles will improve with the cheek filler, as the skin stretches. If it dosent a small amount of filler such as Juverderm, Restylane or Esthelis there would help.

Hope you find this useful


Will I Benefit from Under Eye Surgery?

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   Some wrinkling may be improved by lower eyelid surgery.  I would try to determine the type of peel performed and concentration used if possible.   I usually see results with peels, and a peel or laser allows the surgeon to get some of the surrounding wrinkles not amenable to lower eyelid surgery techniques.  There may be a dryness component here as well that would be helped with some skin care products, and finally you may want to consider fat grafting.   Kenneth Hughes, MD Los Angeles, CA


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Photos are poor quality.  Can't appreciate bags, but fine wrinkles noted that may have been aggravated by previous treatments.  A thorough hands on examination should reveal your best options.  Best wishes. Knowledge is power.  Luis F. Villar MD FACS

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 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.