Peri orbital rejuvenation - what is the best approach? (Photo)

There’s response was dictated. I apologize in advance for grammatical errors.
Facial aging is often quite universal and many senior plastic surgeons who focused their careers un facial rejuvenation typically approach the face in a more global way, addressing multiple aspects at the same time, rather than focusing on one area alone.
Often age shows in many parts of the face.
I will focus on the lower eyelid and midface region since that appears to be your main concern.
to start with the area is complex and not always clearly understood by both providers and patients.
There are generally two variables that happen in conjunction and act as opposing forces, the differentiate the youthful face from that of older individuals.
The first is the lower eyelid, which in youthful individuals tends to be tight and snug.
Immediately below the lower edge of the lower eyelid. The upper part of the midface should be full and plump.
With facial aging both of these areas reverse course.
The lower eyelid instead of being tight and snug behind to bulge as the peri orbital septum begins to weaken, allowing the weight of the eyeball to press supporting lower eyelid, fat pads forward.
Immediately below the lower eyelid, the area loses volume and develops a sunken appearance.
When, making an assessment, we typically start by determining if bulking of the lower eyelids is the primary issue, if loss of volume in the upper midface is primary or if they contribute equally.
Determining which is the primary secondary variable helps direct treatment options.
Textbook, treatment for bulging lower eyelid fat pads is reducing the fat through a lower eyelid blepharoplasty.
Reestablishing midface volume can be done using implants, fillers, fat transfer or a mid facelift.
Individuals who present with both variables contributing significantly, will probably have a better outcome, addressing both variables.
This, for example, could be a treatment plan like a trans conjunctival lower eyelid, blepharoplasty with fat transfer of the midface.
The easiest, least invasive, and most forgiving option, would probably be using fillers only to restore, midface volume.
Depending on the significance of the condition of the lower eyelid, fat pads, volume restoration alone can be surprisingly effective.
To get an understanding of what volume restoration alone, using fillers can accomplish I suggest you check out the before, and after pictures on the website of David Mabrie, MD yourfaceinourhands dot com. He is a facial plastic surgeon located in San Francisco. His practice is devoted exclusively to working with facial fillers. His work is some of the best I’ve ever seen.
I’m not suggesting people fly to San Francisco to get filler treatments, but reviewing his results can give a better understanding of the gold standard, and what is possible with the use of fillers alone.
It’s always good to have a reference of what a procedure is truly capable of in the hands of the right provider.
For most plastic surgery procedures, quality outcome is based on two variables.
The first is patient candidacy, and the second is the skill and experience of the provider.
There isn’t all that much patience can do regarding their own candidacy.
What patients do have control over is provider selection.
This means the provider selection is basically the single most important variable and probably in the end more important than what procedure you choose.
Finding the right provider is far more difficult than most people realize.
Most people use poor discretion in deciphering information regarding provider selection.
The best plastic surgeons often do not focus efforts on self promotion, advertising, social media, or Internet presence.
Instead, they focus their efforts on patient care which is what they do for a living. Period.
Famous plastic surgeons are if anything inversely correlated to talented plastic surgeons.
To find the best provider, I suggest patients consider the following.
Start the process by having a good set of standard facial pictures, the same way plastic surgeons take before and after pictures.
Make a list of local plastic surgeons in your community who seem to excel at facial aesthetics.
Reviews can be particularly helpful at finding providers to avoid, but do not necessarily help in finding the best providers.
After having a list of local providers who may be quality contenders schedule, multiple in person, consultations with each of those providers.
During each 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 for whatever procedure the provider is recommending.
Take careful notes during each consultation, especially regarding the provider ability to make a quality assessment and clearly understand what the underlying problem or diagnosis is.
Take careful notes, especially regarding the quality and quantity of before and after pictures.
An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients for commonly performed procedures.
Highly experienced surgeons should in fact of access to hundreds or preferably thousands of before, and after pictures for common procedures.
Being shown a handful of pre-selected images, representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like, or how many of these procedures they have actually done.
There’s no correct number of consultations needed to find the right provider.
Sometimes it is simply a matter of luck.
The more consultations you scheduled the more likely you are to find the better provider for your needs.
The biggest mistake patients make is scheduling only one consultation and then scheduling surgery.
Scheduling only one consultation, more or less eliminates, the need to find the better provider.
Whenever dealing with situations that are inherently complex, patients should anticipate that providers will have different recommendations and different solutions.
In the end quality procedures are always based on having a clear understanding of what the underlying problem or ideology is.
The best treatments are focused at directly treating the primary problem.
unfortunately this is sometimes inherently challenging.
Attempted solutions that partially address the primary problem will give partial improvements.
The best bang for your buck or simplistic approach to signs of facial aging based on the photo included would be volume restoration in your midface.
Fillers are ideal for this.
Fillers are precise, predictable, and forgiving, if patients don’t like the outcome.
Fillers lack is permanence and for some individuals this makes fillers and undesirable option.
Fat transfer is by its very nature, unpredictable, imprecise, and potentially unforgiving if people don’t like the outcome.
Implants are considered by many to be a bit outdated as a treatment option, but was historically used much more frequently.
Mid facelift was very popular in the late 1990s and early 2000s.
The procedure lost some popularity as providers became more proficient with the use of facial fat, grafting and greater availability of quality fillers.
The procedure has great potential, but can have a slightly lengthy recovery in regards to facial, swelling and bruising.
Fillers are in many ways, simply ideal.
Finding providers who truly mastered the art of facial volume restoration using fillers is another story.
There seems to be no shortage of people offering, promising and providing the service.
Few even come close to delivering what doctor Mabrie has been able to achieve in my opinion.
There is plenty of hidden talent in almost every community.
In the end understanding your own candidacy and provider selection are the two most important variables.
I highly recommend people avoid virtual consultations whenever possible.
Generally speaking, I recommend people avoid traveling along distances for elective surgical procedures, but recognize that sometimes travel may be necessary.
The more extensive and involved the surgery is the less appropriate. It seems to travel for the procedure.
Best,
Mats Hagstrom, MD