37, female, under eye hollows - Is lower blepharoplasty possible? (Photos)

Question

Woman 37 y.o. I had these hereditary under eye hollows since childhood with not enough volume. I tried restylane under eyes 5 years ago which improved the area but it gave me Tyndall effect. I still have around 20% of the filler left. I wonder if lower blepharoplasty or fat transfer could help? Or any other procedure? Unfortunately I don’t have PRF or Renuva in my area if that an option.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear VanillaBrownie,

Thank you for your question. Based on your photos and your history, your main issue appears to be under eye hollowing rather than excess lower lid fat. That distinction matters, because lower blepharoplasty is usually best for puffiness or bags, not for a volume deficiency.

In a case like yours, fat transfer would often be more helpful than lower blepharoplasty alone. Since you have had hollows since childhood, this sounds more like a structural or hereditary contour issue. Adding volume is usually more effective than removing tissue.

The first step, however, would be to address the remaining filler if it is still contributing to the Tyndall effect. Even a small amount of residual filler can affect both the color and the contour under the eyes. Once that is fully evaluated, you can get a better sense of what your natural anatomy really looks like.

It is also possible that part of what you are seeing is soft tissue descent in the cheek area. In some patients, the cheek can sit a bit low and make the hollow under the eye look deeper. In that setting, treatment may involve re-elevating or resuspending the cheek with a cheek lift, with or without fat grafting, depending on the anatomy.

Fat transfer can be a very good option for some patients, especially when the goal is soft, natural improvement. That said, the under eye area is delicate, so technique and surgeon experience are very important. In some patients, a small amount of carefully placed filler can still work well, but your prior experience makes that a more cautious discussion.

So in general, I would think less in terms of lower blepharoplasty alone and more in terms of volume restoration or midface support, with or without limited surgical treatment depending on your exam. An in-person evaluation with a board-certified plastic surgeon or oculoplastic surgeon who treats tear trough concerns frequently would be the best next step.

Warmest Regards,

Dr. Stephenson

C. Blake Perry, MD · Answer

You would be a good candidate for lower lid blepharoplasty. This surgery would involve removing the “bag” from under the eyelid and then adding volume to the tear trough and midface where you are hollow. This would provide a smoother transition from the lid to cheek. You would need to have the filler dissolved before surgery. PRF would not improve your situation as you had an anatomical problem, not simply a skin problem. Best to see an eyelid expert.

Tanya T. Khan, MD · Answer

Hello, it looks as though there is some volume deficiency as well as skin hyperpigmentation in the lower eyelid infraorbital / tear trough region. Would recommend first laser resurfacing to boost collagen / elastin production and thicken skin and improve skin pigmentation, and would secondarily consider careful placement of filler to the region as well. Please visit an experienced oculofacial plastic surgeon for best results.

Nelson Lee Novick, MD · Answer

Full face photos that show the cheeks would have been very helpful in this case.  Since the medial upper cheeks constitute a major support for the under-eyes, when there is volume deficit, either with age or from a genetic predisposition, the under-eyes can be left hollow. If indeed this is the case here, then the use of a robust HA volumizing filler for cheek augmentation would not only create a more feminine Ogee Curve for the cheeks, but would likely secondarily improve the hollowing of the under-eye region. You would be wise to consult with a board certified cosmetic dermatologist filler injection expert and best of luck.

Zoran Potparic, MD · Answer

Based on these photos, a transconjuctival lower blepharoplasty with periorbital fat grafting would be recommended procedure. Fat grafts, in particular nano fat grafts, have shown significant improvement of hollowness and dark discoloration of the lower eyelids in our 25 years long experience with this technique. Good luck.

37, female, under eye hollows - Is lower blepharoplasty possible? (Photos)

Answers (5)

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