Am I a good candidate for lower eyelid surgery or should I continue to use filler to minimize fatty lower lids? (photos)

Question

I hav fatty lower lids and have sent photo's to a number of highly regarded surgeons both plastic and ocular and have received differing opinions. Some say I need surgery and others say I don't and recommend filler instead. I've had filler over the years and wanted a permanent solution but not if I'm not a good candidate. Please advise. Many thanks

Andrew Miller, MD · Answer

While a filler can be done, based on your photos, your best result would be with surgery to decrease the fatty bag under the eye plus fat transfer to fill the tear trough and flattened cheek area. This will create a nice smooth surface from the eyelashes down to the cheek that would look natural and youthful. Be sure to see a facial specialist for consultation.

Alan Gonzalez, MD, FACS · Answer

Hello @Brave506843, thank you for your question. Yes you would definitely benefit from transconjunctival lower eyelid surgery to remove the excess of fat in the area and upper blepharoplasty to remove the excess of skin and give the eyes a lively expression. The best course of action is to consult one or several board certified plastic surgeons for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As far as I can see from your photos you have extra saggy skin both under and above your eyes. Also you had wrinkles in your eye corners. For make fresh, young and elegant look I suggest you upper and lower blepharoplasty, fat injection to under eye area. If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation.Best Regards!

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. You appear to be a candidate for lower blepharoplasty to address your under-eye bags. This surgical approach can smooth the transition between the eye and upper cheek by sculpting, repositioning, or removing excess fat, depending on each patient’s individual situation. By contouring and restructuring the lower lid, the eyes can appear more open, awake, and refreshed with results that are long-lasting. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to review your injection history, discuss your concerns with you, and suggest the best treatment option.

Jonathan Cabin, MD · Answer

Hi there, In general, the decision about whether to get eyelid surgery or filler, and which type of surgery to do, is hard to make based on photos alone. It is important to look at the tissues in person to see the nuances related to potential edema (fluid), lid positioning, etc. Looking at your photos, it appears you have some residual filler at the lower portion of your eyelids that is causing the illusion of eyelid bags. You also may have some bags, which would mean you are a surgical candidate, and not a filler candidate. In order to fully assess your candidacy for surgery, this filler should first be dissolved. A few weeks after dissolving, the eyelids can be fully assessed for next options. Hope this helps! Best, Dr. Cabin

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photos. When the bags are mild, placement of fillers is the best choice. When the bags are bad, surgery is the only solution. From your photos you appear to be somewhere in the middle. Go with the advice of the oculoplastic surgeon. He/she is the most qualified in managing this part of the face. 
Good luck,

Donald B. Yoo, MD, FACS · Answer

Common reasons for lower blepharoplasty include tear trough deformity or pseudoherniation of the orbital fat. To create a smoother eyelid to cheek transition, transconjunctival lower blepharoplasty is a great option. Results are very surgeon dependent, so choosing the right surgeon is important. Consult with 2-3 of these surgeons in person and determine your comfort level with their approach, demeanor, and before and after results. Good luck! @drdonyoo

Derek Fletcher, MD · Answer

I recommend transconjunctival lower eyelid blepharoplasty, which uses an incision on the inside of the lid (sometimes called "scarless" lower bleph). I would recommend micro fat grafting for volume restoration of the midface as well. It also looks like you may be a candidate for brow lift and upper eyelid blepharoplasty.

Soon-Dong Kim, MD · Answer

It seems that there are some probs. First of all, as you mentioned, you look tired because of sunken undereyes. In that case, we recommend Lower blepharoplasty + Fat Reposition + fat graft for undereyes. 
Also, it seems that you have asymmetry eyes because of your asymmetry bone structure. As you can see from your photos, the height of eyebrows and eyes are different. What we can fix the the asymmetry eyebrows, only FOREHEAD LIFT (ENDOTINE) can fix it. Also you need full incisional double eyelid + ptosis correction to correct your minor ptosis and make your eyes bigger and fresh. If you have further questions then please leave a message:)

Am I a good candidate for lower eyelid surgery or should I continue to use filler to minimize fatty lower lids? (photos)

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