Lower bleph vs pinch lower bleph? (Photo)

You could consider a skin pinch to help the appearance of the loose skin, but I also typically recommend CO2 laser to tighten the skin and improve the appearance of the skin itself, and Botox injections for the fine lines. Surgery does not treat the fine lines.

You may have some visible lower eyelid fat bags; this is when I would consider a lower blepharoplasty, and I would perform it with fat repositioning and also consider undereye fat grafting for a really nice eyelid-cheek junction contour.

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

Your primary concern seem to be the creepy skin appearance of your lower eyelids. Your lower eyelid fat pads do not seem to be a concern in the photos. A pinch blepharoplasty may be a good option for you since In the photos, the orbital fat pockets does not seem to be herniating forward. In a traditional blepharoplasty, we remove both fat and skin. The skin laxity can be addressed with pinch blepharoplasty or less invasive option is treatment with a CO2 laser to tighten the skin.