Would I benefit from a lower blepharoplasty or should I consider prp first? (photos)

Wow, what a great question. Obviously, it depends on the size of your wallet and the skill of your Board Certified plastic surgeon which will determine order of treatment.

As I'm sure you know, as we get older, every part of your face goes south. If you do PRP first, you will add fullness to your cheeks, fill in the infra-orbital area with fullness rather than flatness, and, for that reason, you may want to try PRP first. Also, it's a lot less expensive and the skill of your surgeon doesn't have to be as great.

On the other hand, your marionette lines will not be improved by PRP and PRP will not tighten the excess skin on your lower eyelids.

If you were my patient, my recommendation would be to do the PRP first. It will improve the flatness of your checks, add fullness to the infra-orbital area, and will somewhat pull up your nasal labial folds without spending a lot of money. With quicker results and a significant amount of surgical skill, you will experience instantaneous happiness.

If you choose to do the infra-orbital lift with tightening of both skin and muscle as described by Dr. Malcolm Paul, you should get better nasal labial fold obliteration but chance the problem of multiple complications and the need for a secondary surgery to get rid of the extra lower lid skin.

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

Before jumping to expensive surgery with prolonged downtimes or resorting to expensive PRP treatments, whose results to date are variable and unreliable, you would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. I have a patient yesterday in fact with exactly the same issue as yours. In a ten minute treatment session, she was treated with a robust, HA volumizing filler for augmenting her cheeks, which not only created a more ideal, feminine, ooval,heart-shaped face, but diminished her smile lines, AND diminished the hollowing, incipient tear troughs and dark circles under her eyes. The results are immediate, typically elicit a "Wow!" reaction, and generally engender little to no significant post-treatment downtime. So, before jumping into expensive surgeries, or falling prey to yet-to-be proven social media-hyped treatments, such as PRP, you would be wise to explore the filler option. Hope this helps and best of luck.