Would a lower eyelid lift be a good solution for sagging skin? 26 y/o (photos)

Question

Hello I'm a 26-year-old woman troubled by loose skin and hollowness under my eyes. Despite trying treatments like Co2 laser and Restylane injections, I haven't seen satisfying results. I'm now considering a lower eyelid lift surgery for a potential solution. I understand the longevity of results might vary, but this step feels important to me. Dealing with these concerns at my age has been isolating. Would surgery be the best solution? (see images) BW

Thomas A. Mustoe, MD, FACS · Answer

I would be very cautious about recollect blepharoplasty. The malar puff you have is difficult to treat is not due to skin excess but rather swelling underneath.  Filler can sometimes cause that problem.  I Would make every attempt to dissolve and then consider fat grafting plus laser. Unfortunately you have a very difficult problem. Choose your surgeon very carefully and overall I don’t think lower blepharoplasty will help you.  Sometimes a midface lift approached through the eyelid (long recovery high complication rate or through a lateral approach has made a big difference but those  are major procedures and could only be recommended after trying other options (repeated laser) and after getting to know the patient very well.

Bora Ok, MD · Answer

Hello from Istanbul! The fine lines you observe around your eyes, especially when you squint, arise from the contraction of the eyelid muscle called orbicularis oculi. For the lines on the outer corners of your eyes, often termed 'crow's feet,' Botox remains the gold standard, recognized for its safety and efficacy. For the hollowness beneath your eyes, a lower eyelid surgery (lower blepharoplasty) may help by redistributing the fat tissue. A midface lift may also be considered, which would elevate the cheek tissue and bring it closer to the lower eyelid. An in-person consultation would be best to decide on the optimal course of action. Best of luck!

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.

C. Blake Perry, MD · Answer

You would be a candidate for lower eyelid blepharoplasty. Judging from your photos, it appears you still have some filler in your tear troughs causing edema. Before lower lid surgery I would try to dissolve all your filler. This will make the “bags” under your eyes look worse until surgery but it necessary to get the best result. Best to have an in person consultation with an eyelid expert.

Zoran Potparic, MD · Answer

Lower, transconjuctival blepharoplasty should be considered first. It may not entirely address the problem but it will produce significant change. Next step should be done not sooner than 1 year later, until result of blepharoplasty matures. Hope this helps.

Lexie Wang, MD · Answer

Hi Polite! This is extremely hard to tell what is going on without seeing your eyes prior to filler. Right now, all I can see is migrated/superficial filler that I strongly strongly recommend you dissolve because it does not look good. Now how much of that is contributing to your "problems", I don't know because I don't know what you looked like prior to the filler. I actually do not feel that you have too much hollowness under your eyes, esp. compared to what's "normal", with the exception of these valleys that I think are due to poor filler placement. For the loose skin, you definitely need to be consistent about doing the laser for tightening and it may require a few sessions to get you there. Thankfully you are young, though, so you likely could get away with doing a skin pinch style lower bleph to try to get some of that "loose skin" but I would be very cautious about that.

Hong Lim Choi, MD, PhD · Answer

It's a valid consideration to dissolve the injected filler and potentially pursue a Lower Blepharoplasty SOOF. However, given your young age, a more conservative approach like a standard Lower Blepharoplasty would be advisable. This approach involves addressing excess skin and fat, providing effective rejuvenation without the complexity of the SOOF technique. It takes into account both your desired outcomes and age-related factors, offering a balanced solution for a refreshed appearance.

Lisa Brostrom, MD · Answer

Hello, and thank you for your question. Some of the prominent rhytids (lines) demonstrated around your eyes with expressive smiling can be reduced with the use of neurotoxin (botox or dysport). It appears that you have some chronic malar (cheek) and possibly tear trough edema (swelling) likely secondary to restylane injections which can obstruct the lymphatic drainage system of the upper cheek and orbital region for up to 8-10 years based on recent studies. This obstruction can cause boggy swelling which is very difficult to correct. I recommend seeing a Board Certified Plastic Surgeon to dissolve any residual filler in the cheek and orbital region. This should allow for a more accurate examination. After dissolving your filler, you may benefit from lower lid blepharoplasty with microfat grafting. This will allow tightening the lower lid, removal of any excess skin, and replacement of volume deficits over the tear trough and malar (cheek) area.See a Board Certified plastic surgeon who specializes in microfat grafting. He or she can formulate a plan to achieve your goals.

Would a lower eyelid lift be a good solution for sagging skin? 26 y/o (photos)

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