Will I get hollowness if I have transconjunctival lower blepharoplasty? (Photos)

You appear to have congenitally bulging medial and middle lower eyelid fat pads. Additionally, you have a drop of scleral show. Depending on your examination, a transconjunctival approach to your middle and medial fat pads may be the best way to remove these bulges from under your eyes. I hope this helps! Sincerely, Dr Joseph

You are a great candidate for lower lid surgery to remove the bags but also fill your anterior midface/tear trough area. Typically this is done by moving her natural fat from your eyelid to your tear trough (fat transposition) or fat grafting (taking fat from another area of your body and placing it around the eyes). In general, fat transposition is part of the lower lid blepharoplasty and does not cost more. Best to see an eyelid expert.

Condition that you have is significantly influenced by malar hipoplasia (small cheek bones) what explains so early start. In addition of transconjuctival lower blepharoplasty which should correct tear trough and fat bags, augmentation of cheek bones by means of fat grafts or small cheek implants should be considered. In person or teleconference consultation with a board certified plastic surgeon with expertise in these procedures is recommended. Good luck.

A properly performed, trans- conjunctival blepharoplasty can accomplish, removing the fat bags without creating hollowness. Taking too much fat out of the lower lid would create hollowness, so make sure you see a very experienced surgeon who performs natural results.

This response was dictated.
I apologize in advance for grammatical errors.
This anatomic area is complex and not always easily understood. In terms of sign shows of premature age, what a true underlying ideologies are and best way to approach correction.
To start with let’s define what an attractive, youthful face typically looks like.
Starting at the eyelashes and working our way down. The lower eyelid should be snug and tight.
As we get to the lower edge of the lower eyelid, there should be immediate plumpness and fullness in the upper part of the midface.
Going from top to bottom it should be snug, followed by plump when we look at signs of aging the two volumes tend to reverse.
Instead of being snug, the lower eyelid shows bulging as the Peri-orbital septum becomes weak, allowing for The three fat pads under the orbit to bulge forward.
Immediately below this, instead of having immediate plump fullness, the midface tends to lose volume, especially right below the end of the lower eyelid or upper part of the midface.
Let’s think of these as two separate problems, that often happen in conjunction, and are of reversing volumes.
Let’s define bulging of the lower eyelid as the lower eyelid bulging and lack of volume in the upper midface as midface loss of volume.
Of these two problems that often happen in conjunction typically one will be primary and one will be secondary.
The best treatment is generally to direct the treatment towards the primary problem first and foremost then give consideration to the secondary problem or consider treating both if the problem is closer to 50-50.
There is going to be some subjectivity, and you’ll definitely find the different providers will assess and view the issue differently based on their training, background, tools, available to them, etc. etc. etc. For example, and Nurse injector is most likely going to recommend midface volume enhancement since they don’t have the skill to offer lower eyelid blepharoplasty.
A plastic surgeon who may or may not be skilled at volume restoration may lean towards a lower eyelid blepharoplasty since in their hands that tends to give consistent quality outcomes.
Ideally, you want to be in the hands of a provider who has equal skills in treating both problems, can assess which problem is primary then prescribe a treatment solution that first and foremost treats the primary problem and gives consideration to the secondary issue. I’m not sure if this explanation is helpful or just confusing.
To make quality assessments, we need full facial pictures.
We never assess any anatomic area without taking consideration to the adjacent area.
Try taking pictures that include the entire mid face and your forehead.
Better yet just take standard facial pictures the way plastic surgeons take before and after pictures.
If we’re going to make an assessment using pictures, then the quality of the pictures becomes very important.
Make sure the angles are always correct and the pictures are taken from sufficient distance to not create a wide angle lens affect.
Think of how mugshots are taken. Profile pictures should be aimed at the temple and make sure the head is at a right angle from the direction of the picture taken.
Your pictures make it a little difficult to assess the lateral lower eyelid fat pads. There is definitely bulging of the lower eyelid fat pads and I would say that in regards to your problem being loss of midface volume versus bulging of lower eyelid fat peds it is pretty close to 60/40 with the bulging of the eyelids being slightly more prominent.
This is true for the medial aspect, but difficult to assess as we move laterally on the face. in a nutshell, your plastic surgeon is totally correct.
The question becomes if facial fat transfer is going to deliver the outcome you are hoping for.
Facial fat transfer is by its very nature unpredictable, potentially imprecise, and potentially unforgiving if people don’t like the outcome.
the fat may survive at different rates, depending on the thickness of subcutaneous tissue, where the grafts are placed. Grafted fat survival is based on a multitude of variables, and one of those variables is the amount of “host tissue” supporting the grafted fat.
This makes grafting fat around the orbit, very difficult, because the soft tissue layers become very thin at the lower eyelid junction.
Compared to grafting, fat, fillers, are precise, predictable, and highly forgiving if patients don’t like the outcome.
Alternative procedures include a mid facelift, and historically the use of facial implants.
People have very different perceptions of what can be achieved using volume restoration alone.
I often refer people to look at the website of Dr. David Mabrie, MD in San Francisco.
He is a facial plastic surgeon whose practice is focused exclusively on treating patients with facial fillers.
His work is some of the best I’ve ever seen. I’m not recommending everybody flight to San Francisco to get facial fillers, but interviewing his before and after pictures patients can get an understanding of what is possible using fillers only.
Once people have an understanding of what the gold standard or what is possible with a single procedure it can be helpful in assessing Other providers outcomes when trying to find the right provider.
When judging before, and after pictures for facial fat transfer, it is critical that patients recognize that early fat transfer results can look very impressive, but do not represent long-term final outcomes.
In order for fat grafting results to represent final outcomes post operative pictures need to be taken at least 3 to 6 months from the date of surgery.
If the after pictures are taken at three weeks They will not be representative of what results look like down the road.
Never assume that after pictures represent final long-term outcomes.
Whenever reviewing before, and after pictures, always confirmed the timeframe of when after pictures were taken.
This is very important in regards to Fat grafting.
To find the right provider, I generally recommend patients have multiple in person consultations.
Bring pictures of your face, the same way plastic surgeons take before and after pictures and use those as reference during the 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 who had the procedure the provider is recommending.
Being shown only a handful of pre-selected images, representing only the very best results of a providers career may be insufficient to get a clear understanding of what average results may look like in the hands of each provider, what your results are likely to look like, or a good understanding of how many of these procedures that surgeon has actually done.
Being bored, certified in plastic surgery with an overall good reputation and years of experience does not mean somebody has mastered every procedure including lower eyelid, blepharoplasty and facial fat transfer.
Fat transfer has one of the steepest and longest learning curves in the field of plastic surgery.
Many people including plastic surgeons, see the procedure as quite simplistic.
In my opinion mastering, this procedure is very difficult.
A highly experienced surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients.
Highly experienced surgeons specialize in these type of procedures should have access to 100s or preferably thousands of before and after pictures.
In my personal practice, I did facial fat grafting for 15 years.
I no longer offer the procedure because the results were in the end to unpredictable.
My practice is focused, almost exclusively on body contouring using liposuction and fat, transfer for breast and body.
I spent 15 years doing general plastic surgery, including lots of facial aesthetics.
A conservative lower eyelid blepharoplasty with modest midface augmentation would be an ideal outcome in your case.
Finding a provider who can deliver consistent quality results is sometimes a little more challenging than people realize.
I generally recommend people avoid virtual consultations, I generally recommend people avoid virtual consultations, whenever happen whenever possible, and instead rely on in person consultations.
It is the patient responsibility to vet each provider to make sure they find the best surgeon for their needs.
There’s no correct number of consultations needed to find the best provider.
The more consultations you scheduled more likely you are to find the right provider for your needs.
The biggest mistake patient make scheduling only one consultation which more or less eliminates the ability to choose the better provider.
Personally, I don’t think you can really find the best plastic surgeon using a computer or cell phone.
It is a time consuming process.
Considering that you’ll be reminded of the outcome every day for the rest of your life and many of these procedures are permanent and irreversible I think spending the time to find the right provider is a worthy pursuit.
Best,
Mats Hagstrom, MD