Which procedure would help minimize the appearance of my under eye bags and excess skin? (photo)

Hi, thanks for your question and photo. Based off the photo alone an upper and lower blepharoplasty seems to be a potential option for you to correct the concerns you noted on above. Since I don't know your medical and surgical history, I'm unsure why other surgeons have recommended against eyelid surgery. Sometimes prior eye surgery or a particular underlying medical condition may increase your risks for poor wound healing or surgical complications, and this may be the reason they recommended against surgery. Without this additional information or an exam its difficult to provide you with a better answer.

You have excess skin of the upper and lower eyelids, mid face and forehead. I recommend an extended browlift to pull the eyebrows up higher and a mid facelift to pull the peri-orbital skin tighter. At the same time, you can undergo upper and lower blepharoplasty.

Best Wishes,

Gary Horndeski, M.D.

It appears to me that you have excess skin under your eyes, but a photo of your eyelids when you are not smiling would be very helpful to evaluate you. If you do have excess skin in the under eye area, this could potentially be improved with CO2 laser resurfacing or with a surgical procedure where some of the excess skin is removed.

It is impossible to see full extent of your peri orbital area on this photo. A series of photos with face in repose would better show your problem. However, it does appear that blepharoplasty of lower and possibly upper eyelids may be considered. Good luck

Thank you for sharing your photo! I would need to examine you in-person to best answer your question. Eyelid surgery has become one of my most popular procedures to remove the fat that is protruding in your lower eyelid area. Saggy and crepey excess skin can also be removed, if needed. You may also benefit from skin-tightening procedures like Thermage, which is a non-surgical technique that uses radiofrequency technology to stimulate collagen and tighten the skin under the eyes with no downtime. The use of certain topical creams can also be helpful to reduce the appearance of dark circles and puffiness around the eyes. I suggest making an appointment with a board-certified plastic surgeon experienced in surgical and non-surgical eyelid procedures.

Further photos or an exam would be needed to determine the best recommendation for you. Typically for excess skin and under eye bags a lower blepharoplasty is advised. I'm not sure why you were told you weren't a candidate. Morpheus8 which you are undergoing is another good treatment. Generally three sessions are recommended for optimal results. Fillers can also help the appearance of the under eye. We recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

A lower blepharoplasty procedure can accomplish removal of the fat bags through a trans conjunctival approach on the inside of the lower lids. When there's excess skin at rest (not when smiling), then a pinch of skin can be removed right below the lash line. In our practice we close this incision with tissue glue. There are no stitches. you also appear to have low set eyebrows, so give some consideration to a brow lift.

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary hyaluronic acid fillers like Restylane, long-lasting micro-fat grafts, blepharoplasties, or combinations of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result. The darkness may be less obvious, but will not be totally eliminated.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Dear Sandy,
You need a lower blepharoplasty. Seek consultation with an American Board of Plastic Surgery board certified plastic surgeon for an examination and discussion of your options, goals and needs. Good luck!

I suppose my first recommendation would be to tell your children if you have them to wear sunscreen every day and avoid extensive sun exposure.
The aesthetics of this anatomic region is complex and can be tricky to both assess and treat.
There are generally two different contour issues that happen with typical facial aging, and on top of that skin texture issues.
The upper eyelids where we can exercise excess skill laxity doing so on the lower eyelids can lead to premature aging and having a pull down eyelid called an ectropion.
In a useful face, the contour of the lower island should be snug and tight without bulging of the lower eyelid fat pads.
The area just below. This should be plump and full of volume in the upper midface.
With facial aging, we often see the reverse with volume bulging in the lower eyelid and a loss of volume in the tear trough and upper mid face.
To make a quality assessment, we need quality pictures. Ideally, we want pictures without any facial expression, which includes no squinting in the picture.
The picture needs to include your full face and pictures include frontal and profile pictures.
Skin excision with the lower blepharoplasty is possible, but needs to be done very carefully and the patient needs to be assessed to make sure they don’t have laxity in the lower eyelid.
Regardless, having skin removed, will create premature facial aging down the line with an eventually entropion developing.
The Akopian can be reinforced with a canthoplasty or canthopexy.
I’m typically not a big fan of removing skin from the lower eyelid, but there are those who have more experienced than me and seem to be able to do it reasonably well.
That still isn’t going to remove the sun damage that is permanent and irreversible.
You may want to consider trying retin A.
Well done Botox can be useful, but it does require working with a very skilled provider to not create secondary issues.
Your picture is limited, but based on the single picture you’ve included, I don’t see a problem with bulging fat from the lower eyelids.
Sometimes contracting the orbicularis muscle can hide bulging of the lower eyelid fat pads due to the muscle being contracted.
The picture also doesn’t show your midface so it’s hard to assess if volume augmentation would be helpful.
I don’t think you’re going to find that there is a single one best option. A oz of prevention would’ve given you high yelling dividends, but we can’t go back in time.
The importance of sunscreen and avoiding excessive sun exposure cannot be over emphasized.
Best,
Mats Hagstrom, MD