Is 38 too young for lower bleph (fat removal)? (Photo)

Question

I had two consultations for lower bleph and buccal far removal. The 1st surgeon I actually scheduled with will do the lower bleph in the office under twilight. He suggested a fat transfer to under eyes as well but I don't want that. I had another consultation and the dr would not do the lower eye procedure saying when I am 68 I may need another surgery and revisions are tricky. I understand that but my eye bags really bother me and there are no alternatives.Is it really necessary to wait?

Sam Speron, MD, FACS · Answer

Thank you for this question. I hear this a lot from many patients in their 30s, and even 20s. Age is not the most important factor when concerned about eyelid sagging or asymmetry. Yes, sagging eyelids can be corrected with blepharoplasty or cosmetic eyelid surgery of either the upper or lower eyelids. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your genetic makeup and anatomy in addition to what exactly is bothering you.  The lower blepharoplasty will help get rid of the under eye fat bag that are bothering you. It is also important to know that surgery doesn’t last forever, the average cosmetic surgery lasts about 7-15 years but can be longer for some people.

I would recommend that you see a board-certified plastic surgeon who is a member of both ASPS & ASAPS and has plenty of experience in eyelid surgery. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope this helps answer your question. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

I would recommend that you see a board-certified plastic surgeon who is a member of both ASPS & ASAPS and has plenty of experience in eyelid surgery. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope this helps answer your question. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Michal Brichacek, MD · Answer

Lower eyelid surgery is a complex problem, and if performed poorly can lead to significant issues. 
Based on your photos, it looks like you have tethering of the orbital malar ligament, fat herniation over top of the ligament, and some cheek hollowing. I feel that the best option for your would be release of the orbital malar ligament through a transconjunctival approach, together with transposition of the medial fat pad, and conservative reduction of the lateral fat. You may not even require any external skin removal, and may find that this alone is adequate. 
Fat grafting to the area could help in addition to this, but you may find you are happy without out. Filler is always an option if you aren't sold on fat grafting.

Leyla Arvas, MD · Answer

Hi, before eyelid surgery you can try under eye filler with cheekbone filler. These two would make you happy. Redensity II is a safe intervention that could be applied to the under-eye area. The procedure is performed with the help of very fine needles. This technique is applied to the upper part of the bone, not under the skin.

Mehryar (Ray) Taban, MD, FACS · Answer

There is no specific age requirement for lower blepharoplasty. What is most important is the technique. It is best to use transconjunctival approach with eye fat bags repositioning, not removal. See an expert.

Zoran Potparic, MD · Answer

based on this photo you seem to be good candidate for transconjuctival lower blepharoplasty. Addition of micro-fat and nano-fat grafts to cheeks and periorbital area would further improve result. Good luck.

Keshav Magge, MD · Answer

Thank you for your question. I believe you are a perfect candidate for a transconjunctival lower blepharoplasty to remove the fat. I have performed this operation in patients much younger than you as sometime this fat is a genetic component and not just do to aging.  I am not sure what the doctor who told you that you would a revision as 68 is referring to. You may have loose skin that needs removed later and revisions in transconjunctival blepharoplasties (which I don’t believe you would need) are not that complicated. Best to speak to a board certified plastic surgeon either in person or virtually. All the best.

Kenneth D. Steinsapir, MD · Answer

To be absolutely honest with you, no one should decided you should have lower eyelid surgery based on this photographs ( or without palpating--fancy medical word for feeling--your eyelid bag). Different things can cause similar appearances. That is why Zoom consultations are a sham. you can do your own examination. Stand in front of the mirror and put your finger on top of your eye bag. If is soft and puffy, it is likely to be lower eyelid fat and will benefit from lower eyelid surgery. If on the other hand what you are feeling is hard, the bag is caused by your orbital rim. Lower eyelid surgery will not fix the issue. In that case, a fussy filler treatment is your very best option. Now let's talk about eyelid surgery. If your issue is caused by fat, transconjunctival lower eyelid surgery is a very reliable means of addressing this issue. It is surgery can and should be performed under light intravenous sedation. The fat in the eyelid is actually conserved and used to provide volume into the groove. This is far better than actual grafted fat. Grafted fat in this location is a terrible option that you will regret. Yes, many surgeons offer grafted lower eyelid fat but it is still a terrible option. The skin here is simply too thin for this. Also many patients gain weight after having had facial fat grafting. They start looking like the round faces of the South American painter Botero. Please do not do this to yourself. The second surgeon is simply telling your that they are no good at lower eyelid surgery and can't help you. Do not take it personally. You need to keep looking for the right surgeon. I strongly encourage you to consider the under eye fillers as well. I might start by removing any prior hyaluronic acid filler in the face. Sometimes over the years, these products accumulate and things we think of as needing surgery, disappear with a sufficiently large enzyme  treatment.

William Portuese, MD · Answer

A trans-conjunctival approach lower blepharoplasty can accomplish your goals by removal of fat through an incision on the inside of the lower lids. No skin removal is required at age 38. It is certainly possible to undergo the procedure again in 20 years, if ever needed.  A revision lower blepharoplasty is not any more tricky than a primary lower blepharoplasty.   In our practice, we do not recommend fat injections to the lower lids.

Robert Singer, MD · Answer

38 is not too young to do a blepharoplasty if the appearance of your lower lids concern you.  Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties.  Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you exactly what to do without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert T. Buchanan, MD (retired) · Answer

Lower blepharoplasty is a general term for multiple procedures to the lower eyelid area. The only option I would have ever considered for you would be a transconjunctival fat transposition. However, I gave them up many years age because they did not give the results I desired or last as long as I thought a surgical procedure should. I also found I could get better results with filler or fat and that the proper filler (I now use Juvederm Voluma) lasted significantly, up to 5 years. I would, therefore, recommend filling the area by a true expert. Unfortunately, they are rare.