What would be the best route to improve my under eyes? (Photo)

Lower eyelid bags in patients with prominent eyes must be carefully managed.

I typically perform transconjunctival (incision hidden on the inside of the lower eyelid) lower eyelid blepharoplasty with fat repositioning. This helps avoid complications such as eyelid retraction and avoids post-surgical hollowing by preserving volume.

In many patients, I also typically recommend undereye / midface fat grafting to give a softer, more youthful, and more refreshed appearance. Even if every ounce of the fat bags are preserved and repositioning, it’s sometimes not enough volume to get a great result.

Some surgeons may either just remove fat or remove fat and perform fat grafting. The first option will causes hollowing and that does not look youthful. The 2nd option results in the surgeon needing to transfer more fat. I have been teaching other surgeons and performing fat grafting for a long time now and I can tell you the less you need to graft, the better. Also, the predictability of fat repositioning is much higher than fat transfer.

Don’t sign up if you’re not feeling right about your surgeon or your procedure.

You would benefit from a lower blepharoplasty with fat repositioning. This will not change the discoloration of the lower lids but will correct the concavity of the tear troughs.

Best Wishes,

Gary Horndeski, M.D.