What type of blepharoplasty would address my under eye sag? (Photo)

Question

I am considering lower blepharoplasty to address under eye sag. I don’t have bags but do have extra skin (when I pinch extra skin, I see the results I like). In talking to a few local clinics, one suggested transconjunctival, another, the transcutaneous approach. Another told me I just need a “skin pinch”. The last one thought I should address my hollows with fat transfer. Need advice on best procedure would be the best fit for me (loose skin under eyes and hollows under eyes and tear trough.

Andrew Miller, MD · Answer

Based on your photos, a transconjunctival approach won't do to much. Making an incision under the eye will allow some skin to be removed and the muscle tightened. Some fat transfer should be done, though, in order to fill in the hollows around the eyes. Be sure to see a facial specialist for consultation.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.Without the face-to-face consultation It is hard to say that which surgery will much suitable for you. 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!

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

At least from the photo, there appears to volume loss in the cheeks, which is largely responsible for the appearance of under-eye bags, flattened mid-cheeks and prominent smile lines. The use of an appropriately robust HA filler would very likely not only improve the under-eyes and make a smoother transition between the upper cheeks and the lower lid region, but provide the necessary lift to the mid-cheek to improve the smile lines, as well. In experienced hands, the treatment session should not take more than about fifteen minutes, with immediate results that typically evoke a "Wow!" response. Before going through the expense and downtime of any invasive procedures, you would be wise to consult with an experienced board certified cosmetic dermatologist injector. Hope this helps and best of luck.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  I agree with the surgeon who suggested that you correct your under I hollows which are creating the most visible thing that I see which is dark circles under the eyes.

Although you do not have prominent bags there certainly is some fat protrusion which can be addressed during surgery.

In addition you do not have excess skin that would require skin removal.

A transconjunctival lower blepharoplasty with arcus marginalis release and fat grafting will remove the dark circles under your eyes remove the puffiness that I see and the skin will redraped over your orbital bone and correct the appearance of the "I sag".

You can read more to better understand his procedure at the link below.

What type of blepharoplasty would address my under eye sag? (Photo)

Answers (5)

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