Is there anything I can do to firm up or remove under-eye skin and fat pads? (Photo)

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Thank you for your question. It looks to me like they could have removed some or a little more skin during the lower eyelid surgery. That said, I think that the wrinkles could be addressed without additional surgery. See my friend, Peter Rullan M.D. in Chula Vista. While there are several options, I would ask for a croton oil peel to tighten and smooth the skin. Good luck!

The primary goal of lower eyelid surgery is to remove the fat bags creating the puffy look. The Secondary or minor goal is to conservatively tighten up loose and inelastic extra skin at rest and NOT when smiling dynamically

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 and your age, 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