Under eye hollows/bags and crepey skin (Photo)

Question

I am a 50 year old woman who has under eye crepey skin and wrinkles when smiling. I also have hollows and bags that make me look tired and older. Interested in treatment options. I am 5’8” and average weight.

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

C. Blake Perry, MD · Answer

You are a great candidate for lower lid blepharoplasty. This surgery utilizes an incision on the back of the lid to access your natural lower lid fat that causes the “bag.” This fat is then moved to fill the tear trough and midface to give you a natural transition from the lid to cheek. The skin is either tightened with CO2 laser or in some cases a skin pinch is also performed. Best to see an eyelid expert.

Lexie Wang, MD · Answer

Hi angiemarie. You have several options, and it really depends on how aggressive you want to be. For the lines, the easiest starting point is getting neurotoxin injection to the orbicularis oculi muscle because that will decrease how intensely that ring of muscle around your eye can contract when you're smiling, thus creating less wrinkles. You should expect to get this consistently every 3-4mo or so, and it will definitely take time for this to soften. Because your skin already looks crepey as you say, it likely means that your skin is already losing some of its collagen, so anything to work on boosting your collagen and strengthening your skin will also help- measures like microneedling+RF and excellent skincare and laser will be your friends for this. Finally, for the bags, the best treatment would be to consider a lower blepharoplasty possibly with fat grafting. Good luck!

Michelle Zweifler, MD · Answer

Lower eyelid bags are addressed with removing the excess orbital fat; at times this fat can be transferred into the tear trough to smooth the valleys.  Crepey skin is carefully excised and often with a lid tightening procedure like a canthopexy.    Blepharoplasty give much longer lasting results than fillers.

Ajaya Kashyap, MD · Answer

Thank you for your query. You appear to be a good candidate for lower blepharoplasty , removal of fat pockets with orbicularis tightening, based on your photographs. Please find an experienced board certified plastic surgeon who can examine you and help you with all you concerns. All the best!

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. This is a great question. Based on your concerns, there are surgical and non-surgical options available to help treat the undereye area. I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

Gary M. Horndeski, MD · Answer

You would benefit from a lower blepharoplasty.  The excess skin can be resected and the fat can be used to fill in the hollow areas below.

Best Wishes,

Gary Horndeski, M.D.

Robert Singer, MD · Answer

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: Botox or Dysport, temporary fillers, micro-fat grafts, blepharoplasties and combination of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty and micro-fat grafts to the tear trough depressions 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) or Canadian Society for Aesthetic Plastic Surgery (CSAPS) . You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

William Portuese, MD · Answer

From the limited photographs, do you have herniated, fat pads in the lower legs, and loose crepey skin as well. The primary goal for lower eyelid surgery is to remove the fat pads, creating the puffy look, which is done through an incision on the inside of the eyelid. When there's extra crepey skin, then a pinch technique of excess skin is performed right at the lash line on the outside. In our practice, we close the incisionwith tissue glue.

Mats Hagstrom, MD (license on probation) · Answer

The anatomic area of concern is complex, and there are different opposing variables, showing signs of facial aging.
In a youthful face, the contour of the lower eyelid is tight and snug with immediate fullness in the upper part of the mid face.
With facial aging those two areas create opposite changes. In an older persons face, the lower eyelids begin to bulge due to weakness in the Peri orbital septum with protrusion of the three fat pads around the lower eyelid. At the same time there is a lots of volume immediately below this in the tear trough and upper part of the mid face.
In some people, the bulging of the lower eyelid is primary, and then other people the loss of volume in the mid face is primary.
For some people, both are equally as important. The best treatment should be made based on having a clear understanding of which of these two variables is most important and if one, the other, or both should be treated.
Reducing the fat pads in the lower eyelid is best done with an open or trans conjunctival lower eyelid blepharoplasty. Volume restoration in the mid face can be done using fillers, fat, grafting, the use of implants, and mid face lift.
Of all the options to restore, volume in the mid face, fillers, while temporary probably represent the most accurate, predictable, and most forgiving solution if patients are not happy with the outcome. Fat transfer is very popular, but is more unpredictable and potentially unforgiving if patients don’t like the outcome. Implants have become less popular because of quality fillers. A mid facelift is a bit invasive and leaves patients swollen for a while, but can be an excellent option. 
Different providers will have different opinions on how they make the assessment and recommendations for treatments.
Why the choice of treatment is important it is probably in the end, not as important as the choice of the providers.
Delivering consistent quality work should not be taken for granted. Being board-certified in plastic surgery does not mean that somebody has mastered any one single plastic surgery procedure.
To get an idea of what facial volume restoration that can accomplish simply using only fillers, I suggest taking a look at the website of Dr. David Mabrie, MD in San Francisco. I’m not suggesting people travel to San Francisco to get facial fillers, but viewing his before, and after pictures gives an understanding of what can be achieved in the hands of the most talented providers. His work with fillers is some of the best I’ve ever seen.
There are plenty of talented providers in all communities. There are even greater numbers of average providers.
Finding the right provider is not easy or straightforward.
It is, however, the most important variable in long-term patient satisfaction and minimizing disappointment.
The following are some general recommendations for finding the right provider for your needs.
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. 
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. 
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. 
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

Under eye hollows/bags and crepey skin (Photo)

Answers (11)

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Answers (11)

More Eyelid Surgery Questions

How common is entropion after lower blepharoplasty done from outside the eyelid?

Do I need upper and lower blepharoplasty, please? (Photo)

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