Upper Eyelid Hooding and Lower Eye Tear Troughs/bags? (photo)

I have been dealing with hooded eyebrows/deep dark tear troughs since a teen. I always looked ill, or as if I lived on no sleep.In 2005 I began restalyn injections for the tear troughs, and was the answer for a number of years. Recently, the filler has not been giving me the same results as in the past. I continue to look tired, have discoloration under the eyes and have under eye bags despite the filler.The ever growing droopy lids is adding to the problem.Is 28 to young for upper/lower bleph?

Doctor Answers 4

Upper Eyelid Hooding and Lower Eye Tear Troughs/bags?

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     I think that the upper eyelid hooding can be improved with a conservative skin removal of the upper eyelids.  The lower eyelids may benefit from some fat removal or repositioning, but this will require an exam.   Kenneth Hughes, MD Los Angeles, CA

Consider browpexy

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Based upon the photos that I see, I would consider upper eyelid blepharoplasty, including browpexy to address the lateral hooding, and for the lower lids I would consider fat transfer to the upper and mid-cheek.  Browpexy is a neat little procedure which can be performed through the upper blepharoplasty incision.  It repositions the lower edge of the ROOF pad (Retro-orbicularis occuli fat) to above the orbital rim.  It appears as though your ROOF has fallen, and that is the major contributor to your hooding.  Your lower lid position is good, and you don't have herniated fat pads, so I would avoid open surgery on your lids at this point.  What you really need is something to build the volume in your cheeks adjacent to your lids - the lid-cheek junction, and that can be done nicely with fat.  Your age alone is not a factor in whether or not to do the surgery for me; it really boils down to the question of there being correctable anatomical issues, and I think there are.  Good luck.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

Upper Eyelid Hooding and Lower Eye Tear Troughs/bags? (photo)

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Hi and thanks for your question.

It looks like you have a mild upper eyelid ptosis ( droopy eyelid), if you compare your current photo to one taken 10 year ago you can appreciate the change. Yes you will benefit from a upper blepharoplasty and ptosis correction performed simultaneously. Regarding the Lower eyelid, the dominant feature is that of a tear trough deformity. So if you undergo a lower blepharoplasty, correction of the tear trough should be part of the plan. You need to find a Plastic Surgeon who has a special interest in Eyelid Surgery.

Hands On Exam byVillar

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A thorough physical examination (touch and feel) is essential to determine the  appropriate technique suited for each individual patient.  Poorly lit photos will generate a lot of bad advice.  (even from me)   It is always better to do the best procedure that deals with the problem and get it right the first time. 

With these pictures, it appears you may be a candidate for upper lid blepharoplasty without brow lift, and lower lid techniques that deal with the herniated fat and trough.

However, without a touch and feel exam, do not accept any advice as reliable.


In skilled hands you could reasonably return to work in one week.  Full unrestricted activity is typically at three weeks.   Best wishes.  Knowledge is power.  Luis F. Villar MD FACS

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

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