Age 48, alternative to lower blepharoplasty for mild/moderate lipotosis? (Photos)

Question

I’m am 48 yo with moderate lipotosis/eye bags. I’ve had some success with micro needling + PRP (4 sessions total). Unfortunately lower blephoroplasty is very likely contraindicated due to chronic dry eye. What procedure would yield the best/longest results? TIA.

Randal Haworth, MD, FACS · Answer

Considering your chronic dry eye condition and your goal of addressing moderate lipotosis/eye bags, a non-surgical option that may yield the best and longest-lasting results is under-eye dermal fillers.

Dermal fillers can help add volume and smooth out the appearance of under-eye bags. They are injected into the targeted areas to provide a more refreshed and rejuvenated look.

Dermal fillers can effectively address hollowing and depressions under the eyes, reducing the appearance of bags and improving the overall contour. The results can typically last anywhere from six months to 10 years (Renuva), depending on the specific filler used and individual factors.

It's important to consult with a qualified dermatologist or plastic surgeon who has experience with under-eye treatments and can assess your specific condition. They will be able to evaluate the extent of your lipotosis/eye bags, discuss your treatment options, and recommend the most suitable approach based on your individual needs and concerns.

Additionally, it's essential to disclose your chronic dry eye condition to the practitioner performing the treatment. They can take the necessary precautions to minimize any potential risks or complications associated with your specific condition.

I hope this helps,
best of luck !

Hung William Song, MD · Answer

You would be a perfect candidate for a SCEFI fat transfer. When properly performed, a Stem Cell Enhancing Fat Injection treatment can help to recruit your own stem cells and rejuvenate the area. The injected fat will help add a little bit of volume where it is needed, but more importantly, the stem cells in the fat will help tighten the skin, make it more flexible and supple and build collagen in the skin. The signals sent out from the fat stem cells will recruit more stem cells from your body and further enhance the effect. The SCEFI fat transfer results can last indefinitely, but can be repeated to further enhance the effects. Another option is PRF injection to the area. Multiple treatments and maintenance is required, but PRF treatments are very safe and easy.

Anya Costeloe, DO · Answer

Hi! Thanks for sharing your photos. You are a great candidate for under eye deep laser resurfacing. I perform this using Erbium:YAG, another laser that is used is the CO2 laser. 
In your first photo it looks like you have either a festoon or under eye/cheek filler. If it is filler, I would recommend dissolving it. If it is a festoon- the laser will help with this.

Mahmood Siddique, DO · Answer

For mild to moderate lower eyelid fat prolapse (lipotosis) at age 48, especially when lower blepharoplasty is not suitable due to chronic dry eye, there are several non-surgical or minimally invasive alternatives that may help improve the appearance:
1. Radiofrequency Microneedling (e.g., Morpheus8)
* Tightens skin and stimulates collagen* Can help firm the under-eye area and improve texture* Results improve over time with multiple sessions
2. CO2 Laser (Fractional)
* Resurfaces the skin and tightens mild laxity* Can smooth under-eye wrinkles and reduce crepey texture* Offers longer-term improvement with proper aftercare
3. Injectable Fillers
* Can be used to soften the transition between the lower eyelid and the cheek (tear trough area)* Helps camouflage the appearance of mild puffiness* Results are temporary but immediate
4. PRP or PRF Injections
* Stimulates tissue regeneration and collagen* Can improve skin quality and reduce mild puffiness over time* Works best in combination with other treatments
Each option varies in terms of recovery, results, and longevity. A combination approach, like microneedling with PRP or RF, often yields the best outcome when surgery isn’t an option.

Danielle Shanley, MD · Answer

For longest-lasting results, radio-frequency microneedling + laser resurfacing would be a strong combination for skin tightening. Fat repositioning or reduction is another option if the protrusion is significant and surgery is reconsidered. Fillers provide a great quick fix but are temporary.

Erin Smith, MD · Answer

Hello and thank you for your question. To address lower eyelid skin laxity in a non-surgical fashion, a reliable option would be a CO2 laser resurfacing. This can help to tighten the lower eyelid skin. You may benefit from an in person consultation with a board certified facial plastic surgeon to best address your concerns.

Shanthala Shivananjappa, MD · Answer

For mild to moderate lower eyelid lipoptosis, it may be possible to explore non-surgical alternatives to lower blepharoplasty, especially given your history of chronic dry eyes, which makes surgery less ideal.

One option to consider is UltraClear Laser Coring, the latest innovation in laser technology and the #1 non-surgical laser option for tightening lower eyelid skin, improving texture, and reducing excess fat bulging with minimal downtime. Unlike traditional laser resurfacing, laser coring removes micro-columns of tissue, making it a potential alternative to surgery.

However, because the periorbital area is delicate, it is critical to consult with an experienced physician who specializes in this area—whether that is a board-certified oculoplastic surgeon, plastic surgeon, or dermatologist with expertise in laser coring. Physicians like Dr. Brian Biesman, & others are very well known for his work in this field, are great examples of experts who can assess your case and determine the best approach.

I hope this helps! I encourage you to seek out a highly skilled specialist who can provide the best possible guidance for your specific needs. Wishing you the best!
Dr.Shanthala

A. David Rahimi, MD · Answer

Laser resurfacing creates heat which can shrink the skin. I have had a lot of success tightening lower eyelids ( and the entire face) with aggressive micro fractional co2 laser resurfacing. Healing time is 5-7 days. I often combine this modality with judicious application of fillers.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Pasha Mostofi, MD, DMD · Answer

Hello!
That's a good start with microneedling + PRP, however, another good non-surgical method would be trying microneedling with radiofrequency (example being Morpheus8). You would likely need three session, 1 month apart. This therapy tightens skin and to a lesser degree might even decrease the size of the three fat pads below your eyes (we all have them anatomically speaking) by zapping a little of the fat. The procedure can be painful depending on the intensity or protocol used with the therapy, but some local anesthesia (numbing) can help quite a bit with that. Hope this helps!

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