Recommendation For Loose Eyelid Skin and Volume Loss for 25 Year Old? Lower Blepharoplasty? Pinch & Peel? (photo)

I'm 25 and I already have loose and sagging eyelids. I've tried laser treatments twice, botox, and fillers but nothing seems to help. My eyes always look tired and sad. My face has lost a lot of volume in the past year. No weight loss, non-smoker, I guess i'm just aging prematurely. What do you think would be my best option to fix this?

Doctor Answers 9

Rejuvenate Lower Eyelids with Fillers

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Given your age and lack of volume, surgery is probably not necessary. You may benefit from non-surgical procedures like fillers (for example; Restylane, Perlane, Juvederm, Sculptra and Radiesse), which could help rejuvenate your lower eyelids by adding volume. Just make sure you choose an experienced injector.

Surgery is not always the answer

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Many times, surgery is appropriate to rejuvenate the lower eyelids. However, given your age and lack of volume, surgery is likely not the answer. In your case, adding volume will nicely rejuvenate your lower eyelids and help you address your concerns. An easy solutions is to put a dermal filler (like Restylane) in your lower eyelid region. It is a quick fix that will help alot.  

Sandy Sule, MD
Dallas Facial Plastic Surgeon

Volumizing Fillers Work Well for Reinflating, Lifting, and Recontouring Sunken and Hollow Facial Regions

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Probably the greatest revolution in our thinking about how we age came only about fifteen years ago with the realization that aging was not so much due to laxity (looseness) of our skin, but from the loss of volume. Imagine a balloon that has lost its air. The saggy, loose-looking balloon skin is really not lax; it's just lacking air. Reinflate the balloon and voila, the balloon's exterior is once again as smooth as before.

This is pretty much the situation with our skin. With aging (and according to individual genetic and environmental influences, individuals age at different rates), the underlying fat pads shrink and shrivel under our eyebrows and in our cheeks and go South with gravity and the bones of our cheeks and chin likewise lose bulk, as does the cartilage of our nose. The result, the overlying skin redrapes itself over the deflated areas and looks loose and saggy. Inflate these areas with the appropriate volumizing agents and you can almost immediately see the restoration of the youthful shapes and contours.

Laser treatments, which, at best largely affect (when they actually work)the skin surface are more useful for treating very fine crinkles and brown spots. Botox and other neuromodulators, like Dysport and Xeomin work on the underlying muscles of facial expression and have little to no effect on loose skin. Appropriately chosen, volumizing fillers, like Perlane L, Juvederm Ultra Plus XC and Radiesse (not lighter line fillers intended for more superficial lines and etchings on our skin) in the hands of experienced injectors can help to raise and realign sunken eyebrow areas, give some elevation to loose eyelids, and to improve hollows and tear troughs under the eyes and even lighten dark circles. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Photos are a bit tough to assess

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Volume loss can certainly be a problem. Looking at your upper torso, it seems to me that you are quite thin in general. ANd even though you indicate you haven't had a recent weight loss, thinner patients certainly will have less facial fat as well.

Botox will not have any effect on this problem. Fat injections and fillers are usually helpful.

Get a second opinion from an cosmetic surgeon that has experience in periocular rejuventation. An oculoplastics surgeon or facial plastic surgeon is your best bet.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Loose eyelid skin and aged eyes.

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Need better photos. You need to see an experienced eyelid surgeon to see your lids in person to give you the best advice. No fat injections to lower lids!

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Loose eyelid skin

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I'm not sure how we are supposed to assess your sagging eyelids when you've covered them up in the photos!! Some people, genetically, form facial lines earlier than others. 25 is quite young. WIth that smile, you don't look sad! I am troubled to see someone at your age spending money on laser, botox and fillers instead of enjoying life and focusing on the positive. I would encourage you not to obsess about your eyes, at this point in your life, not to buy into any myths about what and how you are supposed to look like, and to find a dermatologist or plastic surgeon who will take a very conservative and supportive approach.

Eyelid surgery for 25 year old

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You have very good skin tone. By looking at your periorbital region, ideally, lower lid blepharoplasty would be one componenent of restoring volume and shape. Fat graft injection would also be ideal to complement your facial features in order to achieve optimal facial contour. Have a formal consultation with your plastic surgeon and take into consideration about what he/she has to say about achieving overall facial contouring. Hope this helps.

Dr. Vu

Kim-Chi Vu, MD
Portland Plastic Surgeon

Loose eyelid skin and volume loss in twenties. fat grafting for facial fill and balancing can be the answer!

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The best option to correct your complaints would be to restore natural shapes and volume to your face by balancing it with fat grafting.  Fat grafting, or fat transfer is very misunderstood.  There are many different techniques that are advocated, many of which kill the fat and only cause problems.  The second problem with fat grafting's reputation is that it really matters where you put it!  If the operator is not aesthetically in tune patients will recieve strange appearing results.  I have had great success treating patients with similar findings from the early twenties to fourties with fat grafting alone.  I would expect that this technique would be all that you need although your eyelids would need to be examined to rule out canthal laxity, muscular laxity and degree of fat herniation.  It is sometimes necessary to tighten the lower eyelid with a blepharoplasty as well.  I hope this helps!


All the best,


Rian A. Maercks M.D.

Tired of tired eyes....

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Eyelid bags or pseudoherniation of the fat of the eyelids is often a complaint of many patients.  "Tired eyes" maybe be due to many problems, including medical issues which may need to be addressed.  You mention that your face has "lost a lot of volume" over the past year.  As the cheeks descend, two noticeable things happen; one your folds at the junction of your lip and cheek (nasolabial folds) deepen and eyelid "bags" often appear.  The eyelid appearance is due to fat "loss" in the eyelid-cheek junction.  The surgical options that exist is to lift the cheek back into a higher position or blend the lid-cheek junction with fat from the eyelid or fat injections.  Filling the face with your own fat may be a great option for you.  I have found performing an lower lid blepharoplasty with fat "bag" removal/re-positioning of the fat into the lid cheek junction to be a very excellent procedure for this problem.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.