25F - What are the risks of getting lower blepharoplasty at a young age? I was told I was too young for surgery.

Question

I’m 25 years old, female. In the past year, my eye bags have become more prominent. It seems like a lower blepharoplasty with fat repositioning is a good option. I’ve had two consultations with two doctors and was told I’m too young. Both doctors said I DO have a mild case of herniated fat below my eyes, but that I don’t need surgery unless it really bothers me. What does it mean to be “too young” for lower blepharoplasty? What are the risks?

Jacob Sedgh, MD · Answer

Besides the routine risks with any surgery including pain, bleeding, infection, potential for poor cosmetic outcome and asymmetry, there will be scarring from the surgery that will make future surgery on your eyelids more risky and challenging when the signs of aging become more prominent. At 25 it is very uncommon to have developed enough laxity of skin and soft tissue from the aging process to warrant those risks.

Michael P. Morrissette, DDS, FACS · Answer

I don't think age is a necessary criterion for determining whether you need surgery or not. Some patients have a congenital predisposition for lower eyelid prolapse. A clinical examination would determine if you would benefit from this procedure. The risks of the surgery are essentially the same at any age.

Mehryar (Ray) Taban, MD, FACS · Answer

There is no specific age for lower blepharoplasty. Although usually patients are older than 35-40, there are certainly some patients who have visible under eye fat bags much earlier in life. If the procedure is done using minimally invasive technique, it is very safe.

Toby Mayer, MD · Answer

Lower blepharoplasty in the young? Over the past 40 years of doing lower blepharoplasty I have seen many young patients that have herniated fat especially those with allergies. These can be removed from the inside of the eyelid. I need to see photos or do an examination to determine if you have herniated fat and is there enough to warrant a blepharoplasty at this time.

Kenneth D. Steinsapir, MD · Answer

That is generally an attempt at a polite way of saying that the surgeon does not feel they have the skills to satisfy your concerns.  Yes a photograph would be helpful. However, go to the mirror and do your own examination. Put your finger on your "bag."  If what your are feeling is soft, then it may well be herniated fat.  On the other hand if what you are feeling is hard, it is more likely you are feeling your orbital rim.  Herniate fat does beautifully with transconjunctival (no skin incision surgery). If it hard, you are probably a much better candidate for under eye fillers with Restylane.  Not grafted fat is not a non-surgical method. Grafted fat causes permanent alterations in the natural glide planes of the face.  Although immensely popular with surgeons (free filler material) is causes huge issues with patients: lumps, bumps, and changes in how the face smiles.  Don't get fat grafting.  A personal assessment is very helpful.  Consider also posting photographs.

Kenneth Hughes, MD · Answer

Without pictures, it is difficult to evaluate, but lower eyelid surgery for fat removal or Restylane to the tear trough would be two alternatives. Conservative fat removal from an incision hidden on the inside of the eyelid is probably the approach you want to pursue.  Whether you have this done now or later depends upon how much this bothers you. Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Johnson C. Lee, MD · Answer

When determining whether blepharoplasty is the ideal treatment, it is important to look at the degree of fat herniation as well as the surrounding tissue. If you have very mild amounts of fat, then surgery may be a bit aggressive since surgery is not without risks such as scarring or lower eyelid malposition. Mild amounts of fat can be camouflaged with filler etc. If you would benefit from surgery, then it most likely a conservative amount of fat resection to avoid taking out too much fat. Removing too much fat can actually cause you to look older or more tired. Hope this helps!Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Curtis Wong, MD · Answer

is commonly used to dissuade younger patients who seek procedures... especially when it isn't warranted in the opinion of the surgeon the patient is seeing.  But there are always exceptions and if your pads are quite appreciable and not fluctuating with the seasons, time of month, cycles, etc, and its felt you truly could benefit from the procedure, you can find someone to do this for you.  So it really comes down to just how bad your bags are or if its worse in your perceptions and not to others looking at you.  But you can have the procedure if indicated.

George Sanders, MD · Answer

When done properly, a lower lid blepharoplasty at a young age is no riskier than at an older age. If the procedure is done via the inside of the lower eyelid, the procedure generally goes well.Depending upon your situation, either fat removal, repositioning, or fillers may work. Please visit with a plastic surgeon for an evaluation and explanation of your best options.

William Portuese, MD · Answer

A full set of pictures and an in-person examination will be required to make a determination about how best to proceed. At that age, surgery can be performed on the lower lids, however the amount of bags should be very significant to warrant undergoing that surgery at your age.

25F - What are the risks of getting lower blepharoplasty at a young age? I was told I was too young for surgery.

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