Is my lower eyelid / cheekbone puffiness to difficult to get rid of with lower eyelid Blepharoplasty? (photos)

Question

I have puffy lower eye lids/ puffiness around cheekbones. The bags look like there's fluid or fat that hangs over and stops at the cheek bone. I would love to have a smooth non-puffy look around the cheekbone area. I would like to get lower lid blepharoplasty, is my case too difficult to treat since the puffiness falls in and around my cheekbone area. What should I do? I am prone to scarring, would my lower eyelids keloid or scar badly?

John Kang, MD · Answer

Hi look at yourself smiling in the mirror and take a picture of yourself smiling.. if you carefully look and observe improvements to the lowere eyelid/ cheekbone complex, then lower eyelid surgery will improve your appearance to a degree.
 Based on your pictures, I see puffiness over your cheek eminence or actually lack there of. I see another area of puffiness under your eyes. They are distinctly separate because puffiness under your eyelid is from fatbag where as the puffiness is from interstitial edema which is genetically conducive... 
First, when you smile, you will observe that tightening of your lower eyelid muscle pushes the fatbag back into your eye socket, so your puffy segment under your eye looks better... if this is the case, taking the fatbag out via trans-conjunctival technique meticulously with minimal post surigical edema should erase the inner-upper half of the puffiness... 
Second, when you smile, your cheek eminence will enhance or become more prominent and thereby flattening the Malar bag filled with chronic interstitial edema. One way to mimick cheek enhancement is to put long term filler such as Radiesse or Voluma.  More permanent option would be to undergo Midface lift which will stretch the Malar bag upward. When I am performing this surgery, i will also  advise combining the Midface lift with placement of fat grafting to the tear trough area as well as enhance your Midface and cheek eminence... 
when the puffiness over your lowers eyelid and cheek area improves, the long oblique line which runs from corner of your inner eye to outer area of cheek, seen worse in your left side than right, will also improve to a degree...
We caution our patients the surgery has to be done meticulously with minimal manipulation and interruption of the underlying anatomy of tissues, vessels and ultimately the lymphatic drainage system (which has been compromised in the first place for reasons unknown) and finally, that  improvements will vary from patient to patient.
But, first catch yourself smiling in the mirror and see how much improvement you see to this area...if you visually can see improvement upon smiling and if you choose your surgeon wisely, you will see some improvements... Good Luck!

Jeffrey E. Schreiber, MD, FACS · Answer

Believe it or not, Restylane (a facial filler) is great for filling in the dark circles underneath the eyes. I have done this many times with great results and no surgery!  Therefore, you might want to try this before embarking on surgery.Kind regards,Dr. SchreiberBaltimore Plastic Surgeon

Robert L. Steely, MD, FACS · Answer

Good afternoon!Looking at your photos, I agree that a lower blepharoplasty alone will not address the puffiness over your malar area (cheekbones).  In my opinion you require something a bit more involved such as a mid face lift. This will elevate those tissues higher on your face and give you a more youthful energetic look.I hope this helps.

Kenneth D. Steinsapir, MD · Answer

Your issue is much more than a lower eyelid issue.  You have a mid face problem.  Lower eyelid surgery will never adequate address your issue as well meaning as your eyelid surgeon might be.  I think you could do quite well with mid face/lower eyelid Restylane therapy.  These are fussy services and who does your treatment makes a huge difference.  Please be careful out there.

Darryl J. Blinski, MD · Answer

Best to be examined in person, but appears as swelling in the malar area and serious tear trough deformity. Try a filler to the tear trough like Belotero Balance 1 or 2 syringes And RF external to cheek bones like ThermiTight RF external..

Joel E. Kopelman, MD, FACS · Answer

I agree with the comments of the other reviewers.I would place Restylane in the nasojugal groove and a small amount of Voluma over the malar eminence.

Sean Freeman, MD · Answer

sydneyjones, Although photos are not the best way to evaluate it appears you have what we call malar bags or festoons. Very difficult to improve this with surgery. It is due to interstitial edema and the tendency runs in families. There are some options but none of them are great. Be careful with your choices.

Amiya Prasad, MD - Account Suspended · Answer

Chronic elevation in the cheek area is referred to as malar
edema or malar festoons.  Based on your
photos, you don’t have festoons. Festoons are like bags that hang over the
cheeks.  Mostly likely, that area in your
cheek has edema or swelling wherein there’s fluid within the tissue. This is
mostly caused by smoking, allergies, sinus problems and genetics. The first
three causes area manageable. Unfortunately, the type of swelling which is
caused by genetics is difficult to address surgically. As a facial plastic
surgeon practicing for 20 years, I have seen many methods presented like CO2
laser and cauterization under the skin. However, a lot of those methods can
worsen the problem.

There are selected patients where we try different things to try to do shift the focus away from those lines by a
strategic use of various fillers. We even use platelet-rich plasma. This is
drawn from your own blood which is spun down to concentrate the vascular growth
factors. These factors improve circulation of the skin in that area.

Ultimately, it is a matter of how to improve the appearance but
not definitively removing the swelling in that area. We are all constantly
looking for solutions for this, but if you have any of the previously mentioned
risk factors, try to treat them personally. Until then, I would advise that you
avoid surgery and meet with some doctors to get some opinions. The thing that
we can’t do with photo alone is a 3-dimensional appreciation of the volume and
projection of this area and how it impacts on you. So I suggest a good
assessment through physical examination for you to know how to address your
situation. I hope that was helpful, I wish you the best of luck, and thank you
for your question.

Robert T. Buchanan, MD (retired) · Answer

Without a full history and examination it is difficult to answer specifically.  However, it appears that a full more blepharoplasty/cheek lift where the arcus marginalis (the connection of the lower eyelid muscle to the orbital rim) is removed, the fat is repositioned and the tissues are suspended laterally from the orbital rim would provide you an excellent result.  Make sure that whomever you see has significant experience in lower eyelid surgery including cheek lifting and that they do not plan to remove any fat.  You need to fat in order to pad the area where you presently have the crease.

Ronald V. DeMars, MD (Retired) · Answer

The puffiness I see in your photo is well outside the anatomical boundary of the lower eyelid and would not be affected by a lower blepharoplasty.

Is my lower eyelid / cheekbone puffiness to difficult to get rid of with lower eyelid Blepharoplasty? (photos)

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