Filler, blepharoplasty, or mid facelift to maintain a youthful appearance? (Photo)

Question

I am looking to get something done to help maintain a youthful appearance. I don’t have undereye bags, but when I smile my eyes scrunch up a lot which I don’t care for, and at rest there seems to be hollowing and almost a dent running along my nose/under eye are. What is the best course of treatment here?

Andrew Miller, MD · Answer

At your young age, botox and fillers can easily address most of the things you are concerned about. Surgery can be held until the botox/fillers can't improve everything you want. Be sure to see an expert injector for consultation.

Zeshaan Maan, MD · Answer

Peri-orbital rejuvenation involves some or all of the following treatments:1. Upper blepharoplasy2. Lower lid fat reduction3. Lower pinch blepharoplasty4. Fat grafting to the upper lid5. Fat grafting to the cheek and lid/cheek junction

Farid Brad Mozaffari, MD · Answer

It is difficult to answer your question based on just one photo. Fillers such as Juvéderm or Restylane are possible options for addressing hollowing or dents under the eyes/nose. Typically during an exam, your anatomy and features are evaluated both at rest and on animation, which cannot be duplicated or really seen on pictures. Scrunching of lower eyelids when smiling is normal and depending on your anatomy and muscle structure, this can vary from slight movement upwards to a large change in position. On the outside corner of the eyes/laterally, this can be treated with Botox/Dysport, but centrally it is much more difficult to address.

Zoran Potparic, MD · Answer

Based on this photo it appears that combination of lower transconjuctival blepharoplasty and fat grafting, micro and nano, of periorbital area would create nice improvement. Hope this helps.

Ronald J. Edelson, MD · Answer

You appear too young for a facelift. I recommend going on a few consults to see what options are there to consider

Kenneth D. Steinsapir, MD · Answer

Midface surgery continues to be a very predictably harmful surgery. Rather than being benefited from these surgeries the risk of harm to your appearance and regret are real. I do agree that a simple skin care program is helpful which can be as simple of daily moisturizer with sun protection. An eye cream is helpful. These tend to be more emollient products that face creams are are very helpful to immediately improve the eye appearance. Avoid lash and eyebrow growth serums. These are harmful to eyelid fat and skin and prematurely age the appearance. I do think that hyaluronic filler are very helpful but the treatment is very fussy. The likelihood that you will find an injector where you live who is great at this challenging service is low. Finally do not get fat transfer to this area. It is like injecting scar tissue and does not help the smile area. Less is more until such time as you do need surgery and you are not there yet.

Ram Kalus, MD, FACS · Answer

Thank you for your question and photo. An examination in person would be required to properly evaluate you and make specific treatment recommendations. That said, a board certified plastic surgeon or cosmetic dermatologist can recommend a good skin care regimen to help reduce the dark circles under your eyes and improve your overall skin health. It does not appear that you have an indication for surgery. Best of luck to you.

Michael S. Kluska, DO · Answer

As we age, the bone, a shrink, and the fat in the face go away. This starts at about the age of 30 and continues on. With that said, one of the most natural thing you can do for your face with the background. It helps restore volume in a very natural appearance. This combined with the use of Botox to help soften muscle movement around the eyes would be a very natural look for you.

Mats Hagstrom, MD (license on probation) · Answer

Based on a single picture, I don’t think you need any treatments.
At mid facelift is fairly invasive and has a pretty intense recovery.
I don’t see an indication for lower eyelid blepharoplasty.
Fillers can make almost anyone look better if you’re in the hands of a super talented provider.
Sellers are very provider dependent, and simply having fillers doesn’t really mean anything unless you’re being treated by somebody who really understands aesthetics and has the skill and experience to do with filler injections really well.
For me the gold standard is to work being done by David Mabrie MD in San Francisco. Check out his website to see some before and after pictures of what can be accomplished, using fillers alone in the hands of the right provider.
At this point I don’t think you need surgical intervention.
Best,
Mats Hagstrom, MD

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