Considering lower blepharoplasty for genetic eyebags. Would fillers be a better option because of my age? (Photo)

Question

My mom says she had eyebags even as a child. Now she is 50 and trying to get a lower blepharoplasty, since they have worsened in the last few years. I also have had eyebags as long and I can remember and I would like to get treated. I also have chronic allergies, which make them worse. Would a blepharoplasty be the best course of action for me, or would fillers be a good choice for my age and type of eyebags? I'd rather get a lower bleph, because that will be permanent. But again, my age is a factor.

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.

Harold J. Kaplan, MD · Answer

Hi LoftheL.  You are an excellent candidate fro Restylane injections around and under the eyes.  We prefer Restylane in this area because it is a soft filler that works very well with the thin skin and facial anatomy in this area.  It can help with the contour of the area (filling it out) and also improve the color.  To see other Orange County patients pictures that have had this concern, visit the link below.

Kenneth D. Steinsapir, MD · Answer

However, in cosmetic surgery, less is more.You need an actual consultation to determine what is the basis for your lower eyelid bag.  It could be herniated orbital fat or it could be exposed orbital rim.  One would be soft (fat) and the other hard (bone).  Fullness caused by exposed orbital rim does not respond to lower eyelid surgery.  You are young with excellent skin tone and should do extremely well with under eye fillers.  The key is not being over done.  You need a lower eyelid.  If you are over filled the result is very unnatural.  Done well, know one will know that you had service and the results can be as good or better than surgery.  The place to start is a personal consultation with a very experiences aesthetic oculofacial surgeon who does both excellent facial fillers and lower eyelid surgery.

Michael Law, MD · Answer

You don't mention your age, but obviously, you are quite young.  I think the camera angle and lighting are probably making the hollows under your eyes look more prominent than they typically appear in -person. You certainly are not a candidate for lower blepharoplasty. I find the result of fillers under the eyes unpredictable at best, and sometimes disastrous. At some point in the future, you might consider conservative structural fat   grafting  performed by a plastic surgeon with considerable experience and expertise in creating lasting and natural looking results from this procedure. At this moment, the best option might be the use of make up under your eyes.

Gilbert Lee, MD · Answer

Thank you for your interesting question.  You are obviously young.  And, your mother reports a history of "eyebags" in her youth as well.  This is an important part of your history.  Older people get bulging fat bags as a part of the aging process.  In contrast, young people get protruding fat bags because of an anatomic condition called a tear trough deformity or malar hypoplasia (under-formed cheek bones).   Because your cheekbones do not adequately protrude, the fat under the eyes casts a shadow and gives the appearance of protruding fat bags.So, your fat bags are actually the normal part, and the under-formed cheek bones are the abnormal part (which makes your fat bags look abnormal).Understanding your condition helps you to understand the proper treatment which will give you the most permanent and lasting correction.  This usually means building up the cheekbones (infra orbital rim) by filling in the tear trough with fillers or a tear trough implant.  The following reference will help you understand your condition. Beware of a traditional blepharoplasty which removes fat from under the eye.  Since this does not treat the primary pathology (under formed cheekbone), the bags often recur; or after the passage of time, you may develop a hollow appearance to your eyes (which does not give a youthful appearance).Good luck to you.  I would recommend a consultation with a board certified plastic surgeon.

Robert Singer, MD · Answer

Most expert experienced artistic plastic surgeons have a
variety of procedures at their disposal to produce excellent cosmetic results
in the appropriately selected patient: temporary fillers like Restylane, micro-fat grafts, and
blepharoplasties. There is no one best procedure. Each has benefits and potential drawbacks. Following the advice of anyone who would presume to tell you
what to do based on limited 2 dimensional photos without taking a full medical
history, examining you, feeling and assessing your tissue tone, discussing your
desired outcome and fully informing you about the pros and cons of each option
would not be in your best interest. Find a plastic surgeon that you are
comfortable with and one that you trust and listen to his or her advice. The
surgeon should be certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS).
You should discuss your concerns with that surgeon in person.Robert Singer, MD FACSLa Jolla, California

Amiya Prasad, MD - Account Suspended · Answer

As a practicing oculofacial plastic surgeon for 20 years, I
have operated on people as young as 14-years-old for bags under the eyes. Eye bags
runs in families and I’ve actually operated on 3 generations in the same
family. There are some key important factors that will help you decide which
option is right for you. The first is how prominent the bags are. In your
photo, it appears that they are relatively prominent, but lighting and other
factors can impact how 3-dimensional the bags are. If the bags are very subtle,
then they may be camouflaged with a filler like Restylane or other hyaluronic
acid. But if the bags are more prominent especially when you look up, and they
bulge forward and become even more prominent, then you should consider a lower
eyelid blepharoplasty. In a younger person like you, I would typically do a
transconjunctival blepharoplasty.

In addition, allergies accumulate a lot of fluid in the eye
area. Management of allergies is very important when you are considering
rejuvenation of the lower eyelids. If your eyes are itchy or if you have watery
eyes and you need eye drops, those things should be managed. If you need to
take antihistamines, then take them. Allergies can still affect the appearance
of your under eye area.

When the puffiness is removed, even if you have allergies, it
won’t look as puffy as when the fat pockets were there. You are probably best
served with a blepharoplasty as opposed to using fillers. But as mentioned,
3-dimensionality is something that can only be appreciated in a physical
examination.

Skin quality with allergies is also an issue so you have to
think about good topical skin care. Sometimes people with chronic allergies rub
their eyes a lot and the skin becomes irregular and has an aged appearance. In
our practice, we would routinely do a platelet-rich plasma injection and the
use of fractional CO2 laser. However, it is important first to do a physical
exam.

If your mother is doing her research, it will be good for you
to tag along and have a consultation. I recently did a facelift and eyelift on
a mother and daughter and they supported each other very nicely during their
healing process. This is worth considering when you do your consultation. Most
importantly, understand the level of fat prolapse you have. If it’s beyond a
certain level, you’re probably best served with a  lower eyelid blepharoplasty. I hope that was
helpful, I wish you the best of luck, and thank you for your question.

Considering lower blepharoplasty for genetic eyebags. Would fillers be a better option because of my age? (Photo)

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