Best technique for lower blephoraplasty?
The ideal (gold standard) for treating under eye bags would be transconjunctival lower blepharoplasty (incision inside the lower eyelid) with fat/bags repositioning. It is scar-less, with quick recovery. Importantly, it doesn't alter the eye shape or compromise eye closure. See following link and video. See an oculoplastic surgeon.
There are many techniques which can be utilized during blepharoplasty, to help you achieve more youthful upper and lower lids. Fat transposition and canthopexy are just a few of the many techniques which can be used. I would suggest you visit a surgeon who specializes in cosmetic eyelid surgery for a consultation. Good Luck!
Your photograph shows heavy upper eyelid folds, mild fat pad protrusion in the lower lids, and a bit of brow ptosis. You may have volume loss in the midface which presents the option of a filler in the cheek area such as Juvederm Voluma. Brow lift, upper and lower blepharoplasty may be done all at the same time - with or without laser rejuvenation. Consultation with an experienced Oculoplastic or Oculofacial surgeon is important to understand your options and see some before after examples of what can be done to help your eyelid appearance. Best wishes with your decisions.
I deal with patients like you frequently. You need someone with all least 15 years of experience who can show you patient after patient who has your problems and what they look like afterward. In summary, people should thing you look great but your eyes should look great without being 'different'. A good surgeon can explain this to you.Hope this helps.Leland Deane MD FACSNYC, Garden City, Babylon
Yes, lower lid suspension and fat removal can be done at the same time. Best to be evaluated in person.
Choice of procedures
The questions are not the choice of procedures but the judgement of the surgeon as to what or how much needs to be done. Get a few opinions in person from surgeons who do blepharoplasties. Consider the one who seems the most conservative and can show results on patients similar to you.
Lower eyelid bags and heavy upper eyelids
Your photo is cropped so you can't see the relationship between your lower lids and cheeks very well. However, from what I can see, it looks like you would do nicely with a conservative removal of fat from your lower lids by the transconjuctival approach (from the inside of the lid). That is the most likely technique to give you a very natural look. It does not appear as if you need any lower eyelid tightening or suspension. Your upper eyelids might benefit from a conservative removal of some skin. From your photos it looks like you may not need any fat removed from your upper eyelids (possibly a small amount from the inside corners).Your best bet is to see a cosmetic surgeon who is experienced in cosmetic eyelid surgery to learn about the options available to you.
from your photos, unless there is weak lower eyelid tone, muscle suspension should not be necessary. Fat removal alone would work nicely for the right lower eyelid. The lift may require a free fat graft or fat transfer, due to a deeper tear trough. Upper eyelids should be a standard skin and muscle excision, more on right than left.
You need an in person consultation, but in general, a transconjunctival lower lid blepharoplasty and a conservative upper lid resection should work well for you. You look young and don't need muscle suspension or skin excision on the lowers.
So many options for lower eyelid Blepharoplasty
I give lectures on this topic frequently. There are many options for lower eyelid Blepharoplasty. Skin removal, skin tightening, transconjunctival (avoiding a cut in the skin), fat removal, fat transfer, fat transposition, and laser resurfacing. Combinations of the above mentioned approaches could be utilized just as you mentioned. The risk of complications are generally a little higher with skin excision and muscle manipulation approaches. Although I have not examined you in person based on the one photo I see it appears your lower eyelids might benefit from a fat transposition technique performed transconjunctivally, With or without fat transfer (live consultation would be beneficial), I see mostly a contour defect and for your upper eyelids to be made to look less heavy with an upper eyelid Blepharoplasty. Thank youDr Schwarcz