Under eye bag help! 38yo male, pale skin (photos)

You are a great candidate for lower lid blepharoplasty with fat transposition. This surgery moves your natural fat to fill the tear trough and remove the “bag.” You also have ptosis of the left upper lid that needs to be addressed to restore symmetry. Best to see an eyelid expert.

Hi K,
There are a few choices to help you. Surgery, a lower transconjunctival blepharoplasty with fat transposition by an expert surgeon only would correct the problem. It appears that you also have ptosis of your left upper eyelid that could be corrected at the same surgery. If your do not wish to have surgical correction then other options include hyaluronic acid filler injection, or if you prefer a 100% natural option, there is a procedure called EZ Gel that uses your own blood to create the blood protein albumin and platelet rich fibrin, when combined form an injectable gel that works well under the eyes. It involves two treatment sessions 6-8 weeks apart followed by once a year maintenance . Good luck and be well.
Michael Persky, MD
Encino, CA

You would benefit from a brow lift to raise your eyebrows slightly higher. You would also benefit from an upper and lower blepharoplasty.

Best Wishes,

Gary Horndeski, M.D.

Yes you are good candidate for lower blepharoplasty. Technique is important to achieve safe and natural results.

At least from the photos provided there appears to be significant volume loss in the upper cheek/lower lid regions, and since this region is a primary support for the infraorbital region, volume loss in the region inevitably leads to the development of under-eye bags, tear troughs and hollows. Since this is the likely scenario here, the use of an appropriately robust HA volumizing filler properly injected into this region can help to diminish, often significantly, the aforementioned problems. As to the left eye, at least from the photos, this appears to more of an issue of eyelid ptosis, rather than hooding. For this, you might wish to discuss with your doctor the use of Upneeq, an FDA-approved, once-daily drop for treating this problem. It is expensive, but you may wish to discuss the use of generic oxymetazoline ophthalmic preparations as an alternative. You would be wise to consult with a board certified cosmetic dermatologist. Best of luck.

Thank you for your question and pictures. From what you show, it looks like you would be a good candidate for lower lid blepharoplasty surgery and then surgery on the left upper lid to correct the symmetry from one upper lid to the other. Be sure to see a Board Certified PS for your consultation who does eyelid surgery.

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, an uper and lower blepharoplasty will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

There are options to help address your concerns. The left upper eyelid is ptotic, which can be improved by repair. This is a relatively small procedure and will help restore symmetry. There is fat prolapse to the lower eyelids. You may have heard about filler, however, in your case because of your bone structure, lower blepharoplasty will likely yield more profound and long term results. An in person evaluation with an oculoplastic surgeon will certainly be helpful in your case! Be well and best wishes.

It looks like you have unilateral upper eyelid ptosis on your left side. To correct unilateral eyelid ptosis can be a bit tricky. You definitely want to find someone who has a lot of experience with this procedure. You may be better off finding an oculoplastic surgeon in your community or plastic surgeon or facial plastic surgeon. Who’s done a lot of these procedures. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of unilateral ptosis repair.
Regarding your lower eyelids, midface, volume restoration with fillers would be a good option, and you may want to consider a conservative lower eyelid blepharoplasty removing a bit of the excess fat behind the lower eyelids. The best resort would most likely come from a conservative, trans conjunctive blepharoplasty removing some fat and restoring midface volume together.
The key is fighting the right provider, and this may require looking around a bit. I suggest scheduling multiple in person consultations with providers in your community. There’s no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely are to find the best provider for your needs.
An experienced provider should have no difficulty showing you the before and after pictures of at least 50 previous patients. Highly experienced surgeons that should in fact have access to hundreds or preferably thousands of before and after pictures.
Being shown a handful of pre-selected images, representing only the best results of her providers career may be insufficient to get a clear understanding of what average results look like, what your results are likely to look like, or how many of these procedures they actually performed.
Best,
Mats Hagstrom, MD