Male, 39, 6'1, 240lbs, fair skin - how to address tear troughs & droopy eyelids? (Photo)

This part of the face is complex, and sometimes difficult to understand and treat.
Facial aesthetics are primarily determined by facial bone structure.
Some individuals have a genetic predisposition to facial bone structure that is unfavorable to facial aging.
Lack of midface, volume and projection is one of those variables.
Changing the facial skeletal structure even though it is often at the root of the problem is seldomly done so people often look for soft tissue solutions to treat problems that are primarily based on bone structure.
It may seem like the problems are related to soft tissues, but in reality it is bone structure that sets people up for premature aging.
This is true for the midface, and it’s true for the lower one third of the face as well.
Individuals who are predisposed to premature aging in the lower 1/3 of the face tend to have a mandible that is small or lacking in projection.
Individuals who have issues in their midface tend to have problems related to their maxilla.
And the youthful face we tend to see a contour that is snug and tight around the lower eyelid with plump fullness in the upper midface immediately below the lower eyelid.
In facial aging, we see the reverse.
The lower eyelid begins to bulge instead of being snug and tight.
The area immediately below the lower eyelid becomes hollow instead of being plump and full.
Sometimes it can be helpful to first differentiate if fullness in the lower eyelid is primary or if midface volume loss is primary.
Again, the ultimate primary reason is based on bone structure.
The best treatment course usually addresses both problems of the lower eyelid and midface volume simultaneously.
There are a number of ways of addressing this.
Fullness in the lower eyelid can be treated by removing fat pads beneath the lower eyelid through a lower eyelid blepharoplasty.
Removing skin and orbicularis muscle of lower eyelid can increase risk for developing a worsening an ectropion or setting people up for developing an ectropion in later in life. Some providers may suggest repositioning or transposition Ing, the fat of the lower island into the tear trough space.
Volume in the midface can be restored, using fillers, fat grafting, implants, or mid face lift.
This area is inherently complex, and there is no one single best procedure.
Expect a different providers to have different opinions about what is the most useful treatment.
In the end, finding the right provider is probably more useful than which treatment they choose to fix the problem.
Considering the complexity and how challenging this area can be to treat I suggest being more selective regarding provider selection than you may think necessary.
To find the right provider in regards to getting a quality assessment and valid treatment options I suggest scheduling multiple in person consultations with plastic surgeons in your community.
You may want to consider consulting with oculoplastic surgeons, as well as plastic surgeons or facial plastic surgeons.
It may be of use for you to check out the website of Dr. David Mabrie MD in San Francisco. his practice is devoted, exclusively to working with facial fillers.
I’m not suggesting people get on a plane to get facial fillers.
His work with facial fillers is the best I’ve ever seen.
Seeing his results conserve as a good teaching tool to understand what can be accomplished, using fillers alone in the hands of the right provider repaired?
Some providers may lean more towards removing than adding, and others will recommend adding rather than removing and some may recommend a combination of both.
If there was one single best procedure, then we would all be doing it.
Because there isn’t this area is complex and therefore expect different providers to have different opinions.
I cannot emphasize enough the importance of provider selection, especially when considering permanent irreversible treatment options.
This type of surgery can be challenging.
Best,
Mats Hagstrom, MD