Help for Saggy Eyelids and Under Eye Wrinkles? Will a Liquid Eyelift Help or Do I Need More? (photo)

Hi there! I am 42 years old. I have had some mild sagging of the upper eyelid for a few years now and recently I have been noticing alot of crinkling/wrinkles when I smile. They are not really that visible when I am not smiling, but are starting to. It makes me look so old. I also have some sleep lines that are midly visible when I am not smiling under my eyes. Will a liquid eyelift using botox and fillers help with this? Laser? Any suggestions would be great!

Doctor Answers 11

Eyelid surgery vs alternatives

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Eyelid surgery, or blepharoplasty, is a beautiful procedure that yields excellent results and should be custom tailored in every aspect to your individual goals, needs, and anatomy. 

From your perspective as a patient, this surgery is very stealth with relatively simple recovery. From the standpoint of your surgeon this is a very intricate, detailed and fun surgery to perform where assessment and planning are everything!

Blepharoplasty has come a long way and become much more modern in recent years, focusing more on long-term results than just on taking away as much skin and fat as possible. This modern approach yields a much more natural look with much more satisfying long-term results. 

Blepharoplasty will address sagging skin, displaced, bulging fat and excess muscle. Occasionally areas around the eyes, like the eyebrows and sometimes even cheeks, need to be addressed to give a harmonious and comprehensive result.

There are non-surgical alternatives to blepharoplasty, including laser resurfacing, fillers, brow lifting and others, but which of those are applicable to you will be dependent, and a discussion with your surgeon can help delineate those options.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.

Cameron Chesnut #realself500 Physician

Spokane Dermatologic Surgeon
4.9 out of 5 stars 121 reviews

Treatment of Sagging Eyelids and Lower Eyelid Wrinkles

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There are many options available for the treatment of lower eyelid wrinkles.  After reviewing your photos it would appear that you would do best with a lower eyelid blepharoplasty taking out a very conservative amount of fat from the inner lower eyelid compartments and a judicious removal of some lower eyelid skin and lower eyelid support.  I don't think that a combination of Botox and fillers will give you the result that you desire.  

Michael Sundine, MD
Orange County Plastic Surgeon

Lower eyelid lines and wrinkles

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Your posted photo shows sunken eyes with visible bone rims and tear troughs under the eyes and finely wrinkled lower eyelid skin. You cannot botox out these lower eyelid wrinkles because paralyzing the muscle here would cause tearing and inability to fully close the eye. Removal of skin by blepharoplasty can remove some of the wrinkles but cannot safely remove all of them. Lasers or chemical peels are more reliable in removing the fine lines but are temporary because they do not address the root cause of the problem that lies below the skin level. If you want the hollowness and tear troughs addressed you will need fillers or fat grafts. Fat grafts are a better more permanent solution if the fat does not associate into lumps. Either fat or filler will efface some of these lower eyelid lines.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Liquid Eyelift

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Liquid eyelift can help rejuvenate the eyelids.  Liquid eyelift consists of injection of filler (Restylane) and botulinum toxin (Botox, Dysport).  As the eyelids age, they loose volume (get hollow) and wrinkle (secondary to skin laxity and relative prominent underskin muscles).  The filler fills up the hollow areas and the botulinum toxin relaxes the dynamic wrinkles.  Liquid eyelift will not address static wrinkles and droopy eyelids/brows, for which surgery and/or laser/peel might be needed.  See an oculoplastic surgeon for consideration.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Saggy eyelid and lower eyelid wrinkle treatment

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There are many treatment options for the eyelid and upper cheek areas. Your photo does show signs of facial fat loss. Improving this loss with either fillers of fat grafting can be quite helpful. Resurfacing (laser, chemical peel) can be used to improve the fine lines you're concerned with.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Lower lid blepharoplasty will remove sagging skin.

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Lower lid blepharoplasty will remove sagging skin as well as the excess fat --fillers will not do this unfortunately.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Laser resurfacing

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Dear Vikster

There are many ways "to skin a cat", and some of the suggestions offered certainly would be helpful.

Though not an ideal photo, what we can see is a "crepiness" and fine wrinkling of the eyelids, and a hollowing of the upper eyelid sulcus just below the eyebrow.

By looking at your eye photo, once can sense that you may have some facial fat atrophy in other parts of your face as well.

As mentioned before, an in-person consultation would be very valuable for you, but based on what we see, you would benefit from laser resurfacing in combination with fat grafting. I think a browlift at this stage would be overkill.

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

Saggy eyelids, what do I need to look better?

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Thank you for your photo. Although it seems like the shot is angled superiorly, you do show hollowing in both upper and lower eyelids and brows. Without an in person examination it is difficult to give accurate recommendations. I think you would benefit from fat grafting in the eyelids and lateral brow with possible skin excision. You need to see a board certified plastic surgeon for an in person consultation to decide what will give you the best results. Good luck.

Help for Saggy Eyelids and Under Eye Wrinkles? Will a Liquid Eyelift Help or Do I Need More?

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Fillers and Botox will improve the undereye area but will not eliminate the wrinkles. Likewise, an aggressive laser resurfacing of the undereye will smooth some of the skin. The best option is a lower eyelid blepharoplasty which will remove and tighten the extra skin and resposition the small lower eyelid bag. I hope this information is helpful.

Stephen Weber MD, FACS

Sagging Eyelids

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 I assume you are talking about your lower lids? Your uppers could use a minor tweak but the problem is with your lowers. Your best choice is laser resurfacing to tighten up all of those fine lines. Volumizing your entire cheek would help some. Botox could only be used very sparingly just below the lashes.

William M. Ramsdell, MD
Austin Dermatologic Surgeon
4.7 out of 5 stars 3 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.