I Have Several Issues with my Eyes I'd Like to Know What's the Best Approach to Correct Them All? (photo)

I have very dark circles, bags on the sides of my eyes ,folds on top and loose skin under.....i want all the problems fixed but i want a natural look.... What's your expert oppinion....i'm ready to do something about it. Thanks for your best advice based on the pictures provided.

Doctor Answers 9

Blepharoplasty for Excess Fat Under Eyes

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It’s pretty clear you have some excess fat of the lowers-  pseudoherniation-  which can be addressed with a transconjunctival blepharoplasty.  While the dark circles are partly due to the shadowing from the fat, there is also some pigmentation of the skin that can be addressed with a bleaching cream most likely.

Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Bothersome eye bags

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Thank you for your photos and question about eye lid surgery.

  • An upper lid lift (blepharoplasty) will take care of the folds.
  • A lower lid lift (blepharoplasty) will trim and re-drape the skin and the fat inside.
  • Surgery plus skin care (using tretinoin) may be all the dark circles need.
  • For a natural result, see a specialist trained in cosmetic eye surgery - a Board Certified Plastic Surgeon is best, in my opinion. 
  • Hope this helps. Best wishes.

I Have Several Issues with my Eyes I'd Like to Know What's the Best Approach to Correct Them All?

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       Upper eyelid surgery with removal of skin will correct the overhang with minimal recovery or risk.   The lower eyelid would probably benefit from a small amount of fat removal and filling of the tear trough.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Natural eyes

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Peri-ocular aging is a complex process which includes loss of volume of the regions surrounding the eye [brow and cheek], as well as a subtle shifting of the eyelid/eye socket fat from above [upper eyelid] to below [lower eyelid].

You pictures show this deflation of the upper eyelid volume in the multiple folds of skin that is now present [like a balloon deflated of air], and the bulging of the fat into the lower eyelid.

The most natural way to rejuvenate the upper eyelids is a combination of removing a conservative amount of excess skin from the upper eyelid, while adding some volume to the brow/eyelid junction, with careful addition of fat.

For the lower eyelids, I would recommend a repositioning of the bulging fat into the hollow region just below the bulge [tear trough or orbital hollow]. This can also be achieved with using fillers.

Adding volume [fat] to your cheeks can also improve this transition to provide a natural smooth progression from the eyelids to the cheek.

Finally, you may have a very subtle droop of the eyelid [ptosis], especially right eye,  that may be causing you to elevate your eyebrows in compensation.  This eyebrow elevation can actually exacerbated the hollow, deflated look of the upper eyelid.

This can really only be evaluated in person as a dynamic exam is required.

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

Eyelid rejuvenation

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From the pictures you posted, it appears that you would benefit from a surgery on your upper and lower eyelids.  Your upper eyelids appear to have excess skin that is distorting your natural eyelid crease creating an extra fold of skin.  An upper blepharoplasty or eyelid lift simply removes the excess skin on your eyelid which would re establish your natural crease and create a better platform for makeup application.  In the pictures you posted, you also appear to have some fullness under eyes. This is most likely a small amount of orbital fat that is showing and giving the appearance of eyelid "bags".  A lower blepharoplasty is a surgery that can be performed to remove this excess fat to smooth appearance of the lower eyelids.  This can be done with an incision on the inside of the eyelid leaving no visible scar or just below the lash line.  Sometimes if there is excess skin in this area either laser resurfacing or a chemical peel can be done to improve the skin under the eyes.  Many of these decisions about what approach is best for you should be discussed during your in person consultation by a  facial plastic, plastic or oculoplastic surgeon.  

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Addressing eye bags with surgery with a natural look, and treating wrinkles & dark circles with non-surgical skin improvement

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Dark circles are caused by many factors such as heredity and pigment issues. Allergies and sinus issues which are also called allergic shiners may also cause a dark look. The skin under the eyes is very thin which can make the blood vessels and muscles clearly seen. Another cause is puffiness which represents fat pockets. This is also called lower eyelid fat prolapse where the fat under the eyes has pushed forward.

In approaching lower eyelid fat prolapse, a transcutaneous or transconjunctival blepharoplasty is a good approach to reduce and reposition the fat under the eyes.

Skin wrinkling or excess skin in the lower eyelid is usually related to age, loss of volume from collagen, as well as environmental effects. Photo-aged skin will look more wrinkled than skin that has less sun exposure. Unfortunately, some plastic surgeons who deal with excess skin take too much skin that results in lower eyelids being pulled down. Therefore, a thorough physical examination must be done before any procedure.

To improve skin quality under the eyes, I frequently use platelet-rich plasma.  Platelet-rich plasma is a new generation of medical treatment based on regenerative techniques. It stimulates collagen and healing that improves blood supply and quality of skin. I would also consider fractional CO2 laser that is based on the concept of a chemical peel. In chemical peels, the top of the skin is taken off which results in smoother-looking skin. With the use of thermal energy, the skin becomes by  tighter and smoother by using heat to stimulate collagen production. In addition, if there is excess skin, I would typically do a skin pinch blepharoplasty where a thin strip of skin along the lower eyelid is taken away. So, I hope that was helpful to you, and thank you for question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

The Aging Eyelid and its Correction

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You are an excellent candidate for an upper lid blepharoplasty and a lower lid blepharoplasty-midface cheek lift.  Your eyes are very hollow and all fat must be saved and repositioned.  In the past far too much fat was removed in error in the lower eyelids. These procedures are easy and inexpensive.  They can be done awake but it sure is nice to be asleep.  My Best,  Dr C

Upper and Lower Eyelid Rejuvenation

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Thank you for your questions and the photos. I agree, you could benefit from rejuvenation of both the upper and lower eyelids. For the upper lids, the main issue is excess skin. This can be removed with minimal downtime. In the lower eyelid region, you have a couple different issues: 1) hollowness between the eyelids and upper cheek; 2) protruding fat under the eyes; and 3) a small amount of excess skin. In my practice, I would address all 3 of these concerns with one procedure -- an extended lower eyelid lift with fat transposition. This technique uses the fat bags that are under the eye to fill in the hollow space and then removes the extra skin.  The result is a smoother, more uniform contour of the entire lower lid/cheek region. Best of luck moving forward!

Eyelid rejuvenation

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 Thank you for your question. Your upper eyelids would be best treated with  conservative upper lid blepharoplasty. As far as your lower eyelids ,you have two options. You could use filler to decrease the "dark circles" . A more permanent solution would be a  slight reduction in the orbital fat. This can be done by "tightening" the orbital septum or a very conservative reduction of the orbital fat that is protruding. I hope this helps .


David F. LaPatka, MD
Santa Barbara Facial Plastic Surgeon
5.0 out of 5 stars 2 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.