Low bleph - can this cause a sunken eye look? (Photos)

My concern is that you may have some persistent HA To lower eyelids that is causing puffiness in the morning that is dissipating by the end of the day. If there is persistent HA, This may look peculiar after fat pad removal. I hope this helps. Sincerely, Dr Joseph

A lower lid bleph to remove the fat and a small amount of skin should smooth out your lower lid without causing a sunken look. Sometimes a fat graft is used in the tear trough to avoid a deepening of this trough after surgery.

Did any of them mention also doing fat grafting? There are surgeons incluiding myself who do fat grafting as well if needed for hollowing and/or fat repositioning.

A lower blepharoplasty can improve the appearance of under-eye bags and excess skin, but fat removal must be approached carefully to avoid a sunken or hollow look. Over-removal of fat is a common cause of this issue. Modern techniques focus on fat repositioning rather than aggressive fat excision to smooth the under-eye area and create a more natural result.
Since your concern is avoiding a hollow appearance, you may want to discuss fat preservation or transposition with your surgeon. This involves redistributing fat to fill any depressions rather than simply removing it. In some cases, adding a small amount of fat grafting can further enhance results.
The difference in swelling from morning to evening suggests fluid retention, which may improve with skin tightening or repositioning rather than excessive fat removal. Make sure your surgeon understands your goal of achieving a refreshed but not overcorrected appearance. A conservative approach typically yields the best results.
After the surgery you can try laser treatment, several sessions most likely, to improve the skin quality if you end up with fine skin wrinkles. Also mesotheraphy, exosomes, nano fat grafting, and microneedling works really good.
Skin removal can also be done but it should be conservative, honestly I don't think that you need that.

I would be skeptical of pronouncements of what you need based on these photographs. I suspect that you have retained filler. I would start by having this product definitely removed. I strongly recommend avoiding "grafted fat" in these tissues. Your eyelid skin is very thin. Hiding grafted fat is very challenging. Think of grafted fat as injecting scar tissue. Yes, some fat survives by the vast majority of the fat dies and is replaced with scar tissue that will permanently damage how the eyelids heap up when you smile. You won't like this effect. Also the so-called skin pinch almost aways causes more harm than intended. Caution is advised.

It is very likely that a combination of lower, transconjuctival blepharoplasty and periorbital fat grafting would be good option for you. Addition of periorbital fat grafts would correct volume deficiency in this area and furter improve appearance of cheeks, lower/ upper eyelids and brows. Good luck.

Thank you for posting your question here !My answer will be based on the limited information and pictures provided, for a detailed and personalized plan please consult with a plastic surgeon in person.
Lower blepharoplasty can be done in different ways and can be customized to your needs, in certain occasions when fat is over excised a sunken eye look can occur this is more common with upper blepharoplasty but can still happen with lower bleph. The fat can also be re-draped after the tear trough ligament is taken down and that will usually give a little fullness to your upper cheeks and give you a smoother transition.When it comes to skin excision , there are different ways of doing it, but based purely on your pictures and not having the privilege of examining you in person , it is a little hard to say if you even need it , it mostly looks like a transconjunctival lower blepharoplasty with fat re-draping and Co2 laser resurfacing of the skin should be sufficient and will likely give you the results you desire without the sunken eye look.I hope this helps, best of luck!

Dear rogalai,
You would definitely benefit from a blepharoplasty procedure. Current trends in eyelid surgery are to preserve volume in order to prevent the postoperative hollowing that defined the long term result of older, full fat removal, blepharoplasty techniques. Not uncommonly, today we redistribute eyelid fat to both prevent hollowing and to fill in tear troughs. This can be accomplished with a number of variations of blepharoplasty procedures. Seek consultation with an American Board of Plastic Surgery board certified plastic surgeon. Good luck!

A conservative fat removal can prevent the suunken look. You also have more fat in your left lower lid than your right, so more would be taken out of that side. If you're less than 50 years of age, no skin removal is required. We don't recommend fat injections in the peri-orbital area for a multitude of reasons. A trans-conjunctival conservative fat removal under a brief general anesthesia is all that's required. The incision is completely located on the inside of the lower lid.

The lower eyelid and the transition to the midface is pretty complex and not always easy or straightforward to understand or treat.
With facial aging that are usually to opposing the volume changes that happen immediately adjacent to each other.
In the youthful face, the lower eyelid is tight and snug with fullness in the upper mid face.
With typical facial aging these two volumes reverse with bulging of the lower eyelid and loss of volume in the upper midface.Well done volume restoration of the upper midface can camouflage the bulging of the lower eyelids.
It helps to differentiate, which of the problems is primary.
Is the fullness in the lower eyelid more of a problem or lack of volume in the upper midface?
A lower eyelid blepharoplasty may be appropriate.
Personally, I do not remove skin from the lower eyelid because in my opinion, it leads to a premature ectropion.
The potential benefits of removing skin in my opinion is outweighed by the potential negative, even if it’s down the line many years later. In my opinion, whenever skin is removed from the lower eyelid, the patient will at some point develop an ectropion which is premature.
This is just my opinion and other plastic surgeons have different opinions.
Often there is no right or wrong and both volume restoration and removal of lower eyelid fat pads can give good improvements sometimes the best results come from a combination of both.
Fillers are not good or bad but providers are.
Treating this area is difficult and the area is complex.
This is the main reason that patients sometimes have less than ideal outcomes from both surgery and treatment with fillers.
Consider looking at some of the results from Dr. David Mabrie, MD in San Francisco.
Real self doesn’t allow me to include links to websites so you’ll have to look it up on your own.
David work with volume restoration is the best I’ve ever seen.
I’m not suggesting people flight to San Francisco to get fillers, but seeing his results can be a useful tool and understanding what each treatment option can accomplish.
Finding the right provider is in the end, the most important variable, regardless of what treatment you opt for.
Finding the right plastic surgeon is not at all easier or straightforward.
I generally recommend patients have as many in person consultations as possible.
Bring pictures of yourself to use as reference during the consultation.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had similar facial characteristics to your own.
The providers generally only show their best outcomes so it is your responsibility to vet providers and try to get the best understanding you can of average outcomes on previous patients with similar facial characteristics.
The more consultations you schedule the more likely you are to find the better provider for your needs.
With more consultations, you also get more familiar with the terminology and different approaches.
Most people do not have a lot of experience consulting with plastic surgeons so getting some practice is definitely in your favor.
Recognize that lower eyelid blepharoplasty is a permanent and irreversible procedure.
When in doubt slow down and schedule more consultations
Best,
Mats Hagstrom MD