Eye bags and dark circles. Help! (Photo)

Question

I am 26 and my lower eyelids have got really bad in the last two years. It is hereditary, both my parents have bad eye bags. I had restylane done two years ago and I didnt like the results, I had greyish skin and lumps developed months after the injection. Do you think lower bleph with fat repositioning/ muscle tightening would help? I do have a bit of herniated fat. I definetely dont want to have dermal fillers again.

Mehryar (Ray) Taban, MD, FACS · Answer

You appear to be a good candidate for lower blepharoplasty (transconjunctival with fat repositioning).  I advise against transcutaneous blepharoplasty. See link below.

Derek Ford, MD · Answer

I'm
sorry to read that you had disappointing results from fillers in the past.
Nonetheless, I think it's possible that getting Restylane again will provide
significantly different results than your first experience. It may be worth
pursuing before getting lower blepharoplasty. However, as others have said, you
could benefit from transconjunctival blepharoplasty if you decide to get
surgery. This approach would offer significant correction and long-lasting
results. Whichever route you decide, it's important to consult with a qualified
plastic surgeon who specializes in the treatment of your choice. Good luck.

John J. Martin, Jr., MD · Answer

You have some visible fat in the lower lids and a deep tear trough.  Usually at your age some HA filler would be the best option to smooth out the area. It is very unusual to have problems with Restylane in this area if done correctly.  You may want to try this again with a different surgeon.Your other option is a blepharoplasty with fat repositioning, where the fat is moved further down into the tear trough.  This is usually done from the inside of the lid.

Vincent N. Zubowicz, MD · Answer

Fat herniation is not necessarily a sign of aging. In your particular case the lower lids could be handled by a blepharoplasty probably trans-locating the fat from the medial compartment into the tear trough area. This can be done through either a trans conjunctival approach or a more conventional incision along the lash margin.

Jeffrey M. Joseph, MD · Answer

I would not give up on fillers just yet. Correctly placed fillers should be able to smooth the appearance of the lower lids quite a bit. I will say however, that from your photos, transconjunctival blepharoplasty with fat repositioning would be another good option for you.

William Portuese, MD · Answer

The photographs demonstrate herniated fat in the lower lids, for which an incision on the inside of the eyelids can accomplish removal of the fat. This is known as a trans-conjunctival approach. No muscle tightening is required. It's also important to evaluate any allergies that may be present. For many examples, please see the video and the link below

Cain R. Linville, MD, FACS · Answer

Your pic is limited, so I can't be as exact. But, you appear to have weak cheek bones, or a deficiency in your maxilla, with a negative vector. I can't imagine that your restylane was done properly if they didn't tell you about this. Your eye bags, or fat pads, appear to herniate because they are pulled down like the sheet on a bed. Instead of a lower bleph, which is very complicated in a negative vector, you need to build up your check bones I think. Please keep in mind this is based on one picture that is zoomed in and single angle. Ok, so how to build up cheeks? Fat grafting, implants, or Voluma/Lyft for the CHEEKS, not the lower lids. As I mentioned, I don't think your other injector recognized this. I also don't like restylane for your particular issue. Too soft and likely placed in the wrong plane. Oh yes, sculptra could also be used. Seek out an EXPERT, not someone who isn't a surgeon or who is just a hired injector. Otherwise you will be wasting money.

Ronald V. DeMars, MD (Retired) · Answer

It is not common to do eyelid surgery on patients at your age, but when we have someone come in with this familial look and they are not happy with it, surgery is far and away the best answer and there is no reason to put it off. But find an experienced and skilled surgeon who does a lot of transconjunctival surgery.

Eye bags and dark circles. Help! (Photo)

Answers (8)

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