Which Blepharoplasty Technique is Best? (photo)

I most commonly performed lower blepharoplasty by making an incision along the lash margin in dealing with the fat and skin in various ways. Occasionally the trans-conjunctival approach is suitable. There is no one correct way to do the operation. Go with the surgeon you trust the most.

Either option can achieve the result you are looking for. Trans-conjunctival approach to lower eyelids is a safe way to perform lower blepharoplasty. Skin pinch, peel, or laser resurfacing are all well-established modalities that can help with lower lid skin tightening. As evident from other answers, there are additional nuances in deciding whether fat repositioning or grafting would be of benefit. Other views and exam would be beneficial in this regard. Good luck,

 

Grigoriy Mashkevich, MD

New York Facial Plastic Surgeon

Either option can work well for the right patient. For you, peel may be better because it would also diminish the pigmentation spots you have on your lower eyelids and face.  See an oculoplastic surgeon.

I prefer a transconjuctival approach with conservative fat excision and a skin pinch blepharoplasty.

For your case, fat repositioning would be most ideal so deal with the bagginess of the lower eyelids. For the skin treatment, its hard to say with a photo alone. Skin texture, lower eyelid tone need to be assessed in person to determine whether skin peel vs laser vs pinch excision would be best.

I would tend to favor a transconjunctival lower blepharoplasty with fat repositioning and conservative removal based upon the photos you submitted. It does not appear that you have much lower lid skin and a peel or laser resurfacing would help tighten the skin and improve pigmentation issues. Good luck.

Thank you for the question and your photo. It would be useful to see a profile and 3/4 view to determine the relative projection of your cheekbones. In addition, an exam in person is needed to check the laxity of your lower eyelid. I agree with some other assessments that volume would be helpful. In appropriate patients, I use the orbital fat and transpose this over the orbital rim to fill in the hollow area. When there isn't enough fat, I recommend fat grafting to my patients. For the upper eyelids, a skin-only approach is appropriate in many cases.

I agree with the consultant who suggested lower eyelid transconjunctival approach with fat re-positioning   I do not think at your age there is any need to make incisions on the lower lid.  I would also suggest some volume augmentation to the cheek in the form of fat grafting.  Lastly, I would suggest laser skin resurfacing in the lower lid to achieve a small amount of skin tightening.  I would also agree with a "skin only" upper blepharoplasty which would rejuvenate the upper lids.  

If there is excess skin that is significant then you need an external incision. Otherwise transconjunctival is ok. Your uppers should be left alone  and have a browlift instead to prevent hollowness and give you a "happy" look.

In looking at your photographs, I am not certain that what your consulting surgeons have diagnosed as herniated fat is in fact that.  The fullness in the lower eyelid appears to be in a location that is consistent with orbital rim or bone.  This means that you and your surgeons are likely to be quite disappointed with a lower eyelid surgery.  I think that fat removal will do almost nothing for you.  On the other hand, you do have a face full of freckles.  A lower eyelid chemical peel will firm the lower eyelid and may provide all the improvement that you need without the necessity of lower eyelid surgery.  I would be careful of transcutaneous surgery and even skin pinch.  These are likely to also be disappointing.  I would seek out additional opinions and you might even consider full face Fotofacials which would lift out the freckles with zero down time.  I would suggest under eye filler but due to your skin quality this will be a very fussy service and finding a doctor who can pull this off can be hard.