Do I Nead Lower Eyelid Surgery or am I Losing Cheek Volume?

Hello to all:)' I have a kind bumps or shadow in my under eyelid in both of my eyes.When im tiread you can see better or when i have makeup on..I post picture for u see better wich area im talking about.. Do i nead lower eyelid surgery or is the ckeeks nead volume? Note:.If i strech the skin in the area and pull up the bump disapper.So what i nead to do? Thank you to all

Doctor Answers 11

How to remove lower eyelid bumps?

 From the photo, IMHO of performing eyelid surgery for over 20 years, this does not appear to be fat bags of the lower eyelid and therefore a lower eye lift is not warranted.  In fact, the normal lower eyelid muscle is clearly visible in the photo which would be obscured if lower eyelid fat bags were present.  The area that you have drawn is not the lower eyelid but the upper malar or cheek bone.  Bags and fullness here are not related to the lower eyelids but the cheek tissue and are called "malar bags."

 Malar bags are associated with chronic swelling of the tissues in this area and are very difficult to treat.  A lower eyelid surgery will likely make the malar bags more prominent, not less, by hollowing out the lower eyelids.  You cheeks appear full and placing more volume is not aesthetically warranted however, small amounts of a thin filler like Restylane or Juvederm can be used to feather the edges of the malar bags.  Decreasing salt, in the diet, is also recommended for less fluid retention in the area.

Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Top of cheek/lower eyelid volume is needed.

The key here is blending the top of the cheek into the lower eyelid.  This is done by filling the tear trough above the top of the cheek.  Additional volume is needed in the cheek.  Judging from the photographs which is not a substitute for an actual personal consultation, you appear to need  1 ml of Restylane under each eye.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Total Facial Harmony

I agree, the area you have outlined in black appears to be more of a festoon problem rather then the lower eyelid itself.  Although these problems do not happen in isolation from each other, I would first start with treatment of the festoon  (with deeper filler or fat).  If not corrected to your satisfaction, then more aggressive treatments can be offered. 

Don't for get about the rest of your face while chasing after the bags. Your festoons don't look too severe from the photo and you have other aging issues/asymmetries as well which all contribute to the look of your age.  Find someone who will look over your entire face and offer a complete evaluation.  Good luck!

Hannah Vargas, MD
Kansas City Facial Plastic Surgeon
4.8 out of 5 stars 46 reviews

Lower eyelid surgery or cheek augmentation

It is a normal aging process to lose fat in the face as one ages.  The primary goal of lower eyelid surgery is to remove the fatty deposits in the lower lids, also known as bags.  When flat cheeks are present cheek implants are placed through an intraoral approach.  Malar and submalar implants can be placed depending upon the area of hypoplasia. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Facial Aesthetics is function of proportions and balances

Facial aesthetics is seldom a stand alone issue.  It is function of balance, blend and proportions between all adjoining structures.  

Analysis of your posted picture reveals that you are right in your estimation.  You have excess skin on your eyelids and also loss of cheek volume.  You will need blepheroplasty as well as restoration of cheek volume to restore ideal aesthetics.   

Vasdev Rai, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 23 reviews

Lower Eyelid Surgery and/or Increasing Cheek Volume

It appears that filling the crease at the orbital margin with fat or Restylane will be more beneficial than a lower lid blepharoplasty. If cheek volume is not adequate cheek injections or implants could be done. All of these suggestions would be considered at the time of your consultation.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Improving lower eyelid aesthetics

Without an in-person clinical exam, it is not easy to see from the photo if you have bulging lower eyelid fat pads.  If you do, a sub-conjunctival lower lid blepharoplasty would be helpful.  In this procedure the lower lid fad pads are removed via incisions inside the lower lids, so skin scarring is avoided and lower lid shape is preserved.  

In addition, the photo seems to indicate volume loss in the upper cheeks  (tear trough grooves), which is a very common problem.  This issue is easily remedied with hyaluronic acid filler injections, such as Juvederm or Restylane.  I would recommend doing the surgical blepharoplasty first ( if it is indicated), then getting the fillers after the post-surgical swelling has fully resolved.  

Pamela B. Rosen, MD
Coral Springs Plastic Surgeon
3.0 out of 5 stars 3 reviews

Restoring youthful volume to the eye area

There are several steps to a lower eyelid blepharoplasty.  From your photo it appears that the surgical procedure would be beneficial.   There is no substitute for a clinical examination of your lower eyelid.  From an examination we would be able to determine the exact steps required.   A blepharoplasty can involve the redistribution of fat, tightening of the orbicular is muscle, and some degree of skin removal.   The key  to correcting the signs of aging is to restore youthful volume to the orbital zone.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Lower eyelid bags

Unfortunately the picture is not very clear and definitely not a substitute for clinical exam; however, it appears that you have some psuedoherniation of the under eye fat pockets as well as sagging of cheek tissue which caused the tear troughs and lower orbital rims to show deficiency more prominently. Soft tissue fillers can definitely camouflage this area but the results will be temporary and may make it worse if done by an inexperienced provider. A surgical lower lid Blepharoplasty through subcilliary or transconjunctival apprach allows repositioning of the infraorbital fat over the tear trough and the orbital rim as well as tightening of the lower lid skin. A midface lift may also be performed through that incision if necessary. The results are natural and long-lasting.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon
4.4 out of 5 stars 20 reviews

Lower eyelid aging

You have relative hollowness so traditional lower blepharoplasty (with fat removal) won't be beneficial.  The other issue is lower lid skin laxity with early festoons.  For that, surgery may be helpful. The techique is called orbicularis plication.


Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.