49 years old, lost 50 pounds. Under eye hollows and crepey skin - bleph, filler, or something else? (Photos)

Question

I am 49 yrs old and lost about 50 lbs. Now, my face looks a lot older than my age. I have hollows and crepey skin under my eyes. I am not sure what the best solution is. I hate looking in the mirror.

Gary M. Horndeski, MD · Answer

You may benefit from an upper and lower blepharoplasty. The lower blepharoplasty will included fat transposition to fill out the hollows. You may also benefit from a facelift and browlift. I would need more photographs that included the entire face, frontal and side views.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Nelson Lee Novick, MD · Answer

Noticing what appears to be dramatic facial "aging" following relatively rapid and dramatic weight loss is by no means a new phenomenon. It is just being seen much more these days due to the widespread use of the GLP-1 inhbitors. Excess weight provides a kind of mask that hides the normal and gradual aging process we all go through. However, when the "mask" is removed quite suddenly, as with the dramatic weigh losses seen with the newer medications or crash dieting, the face appears to have agred dramatically overnight. It hasn't. It's just that the "mask" has been removed. 
At least from the photos provided, you may wish to consider the use of a robust HA filler cheek augmentation to create a more feminine, oval, heart-shaped face and the use of Botox to address the smile-related crow's feet creasing at the sides of the eyes. You might be surprised to see how dramatic a rejuvenating response can be achieved in this way. 
You would be wise to consult with an experienced, board certified cosmetic dermatolgist injector expert and best of luck.

Vipul Gargya, MD · Answer

Based on your photos, a significant part of what you are seeing is volume loss and deflation after the 50 lb weight loss. The hollowness beneath the eyes can make the entire face appear more tired and aged, even when the skin quality itself is not severely damaged.
In my opinion, fat transfer to the lower eyelid and tear trough region would likely help soften the hollow appearance and create a more refreshed, natural look. Fat transfer is often especially helpful after major weight loss because it restores some of the lost facial volume using your own tissue.
You also appear to have some crepey lower eyelid skin and mild skin laxity. Depending on your goals and examination findings, this can sometimes be improved with adjunctive treatments such as lower blepharoplasty, skin tightening, laser resurfacing, or a combination approach.
The key is avoiding overfilling. The under-eye area is delicate, and the goal should be subtle restoration and smoother transition between the lower eyelid and cheek, not puffiness.
I would recommend an in-person consultation with a board-certified plastic surgeon experienced in facial rejuvenation and lower eyelid surgery to determine whether fat transfer alone or a combined approach would give you the best result.

49 years old, lost 50 pounds. Under eye hollows and crepey skin - bleph, filler, or something else? (Photos)

Answers (3)

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