What procedure would be best to correct my under eye? (Photos)

Question

I’ve very concerned about my under eye area and early aging due to it. Also the crease from my eye into my cheek area is a concern. I feel like I would most benefit from a lower blepharoplasty however am interested in suggestions

C. Blake Perry, MD · Answer

You would be a good candidate for lower lid blepharoplasty with CO2 laser resurfacing. Because of your early festoons (worse on your left side), laser resurfacing would be a must. This would soften the transition from your lid to cheek. Best to see an eyelid expert.

Ruslan Zhuravsky, DO · Answer

Hello,From the photos it seems that the primary issues are skin wrinkling and fullness from what looks to be more like festoons, rather than fat.A bleph would have to be done very cautiously, not a simple skin pinch, and I would not do a traditional removal of fat as this would hollow out the lower Lids. In cases like this I prefer to lift skin (like a flap) then lift the entire muscle, spending it to the bone of the orbit. The reason for this is to avoid ectropion. When skin is simply removed from the lower eyelids, it tightens and pulls down on the eyelid itself. This will sometimes work on the festoons as it tightness that potential space, but it may not. An alternative would be a CO2 laser. This can help tighten and improve the skin quality, and can improve festooned.My favorite treatment for just festoons has been morpheus RF microneedling. When done properly it can have a significant improvement and even resolution. This can also be done a few months after the other two procedures to treat any swelling that may remain. So there are options. The main thing you should be concerned about is to avoid "quick fix" surgeries that do not take into account potential problems like ectropion and hollowing. No simple "skin pinches". Ask how they will avoid those problems. Hope that's helpful. Good luck!

Paul Phelps, MD, FACS · Answer

When the area of concern under your eyes goes down to the cheek there is often a fluid component to the problem. You may want to consider non-invasive treatments like radiofrequency microneedling. Surgery with a blepharoplasty may be able to help, but often in a scenario like this the surgery causes inflammation which may make the under eye area look worse before it looks better.

Mats Hagstrom, MD (license on probation) · Answer

Making an accurate assessment regarding the lower eyelid and midface area can be tricky.
Generally, in an attractive, youthful face, the contour of the lower eyelid should be snug and tight with immediate fullness in the upper part of the mid face.
With typical facial, aging, the volumes, sometimes reverse with the lower eyelid, showing fullness due to weakness in the peri-orbital septum, allowing the three fat pads of the lower eyelid to cause bulging.At the same time, patient often develop a loss of volume and the upper part of the midface.
In your case, I don’t see significant bulging of the lower eyelid fat pads.
What I do see is lines of premature facial aging due to sun damage with malar edema.
I recommend avoiding sun exposure and wearing sunscreen. Very careful use of Botox in the upper part of the lower eyelid may be helpful.
Chemical peels, laser resurfacing or tretinoin may potentially be useful. Long-term reversal of sun damage is inherently difficult and ultimately not really possible.
A lower eyelid blepharoplasty may or may not be useful but I don’t think it is necessarily indicated.
Personally, I’m not a big fan of lower eyelid blepharoplasty including skin resection.
I typically rely on removal of fat pads only.
Skin resection of the lower eyelid typically leads to premature ectropion.
Best,
Mats Hagstrom, MD.

What procedure would be best to correct my under eye? (Photos)

Answers (4)

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