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 10

Treatment of Sagging Eyelids and Lower Eyelid Wrinkles

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.  

Orange County Plastic Surgeon
5.0 out of 5 stars 18 reviews

Lower eyelid lines and wrinkles

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
5.0 out of 5 stars 1 review

Liquid Eyelift

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 70 reviews

Saggy eyelid and lower eyelid wrinkle treatment

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 21 reviews

Lower lid blepharoplasty will remove sagging skin.

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
4.7 out of 5 stars 33 reviews

Laser resurfacing

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 36 reviews

Saggy eyelids, what do I need to look better?

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.

George Marosan, MD
Bellevue Plastic Surgeon
4.8 out of 5 stars 35 reviews

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

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

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Sagging Eyelids

 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

Saggy eyelids and under-eye wrinkles

Excess skin on the upper lids is best treated with an upper blepharoplasty where excess skin is removed through an incision in the upper eyelid crease.  The primary goal of lower eyelid surgery is to remove the fat bags on the underneath side of the eyelids.  This is done through a transconjunctival approach on the inside of the eyelids.  Any excess skin in the lower lids is removed through a subciliary incision directly underneath the lash line and this incision is closed with tissue glue.  The decision to remove any excess skin is made at the time of rest and not during animation on the lower lids.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 139 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.