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

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.

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.

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