Under eye fat pads have started bulging - Am I a candidate for Lower Blepharoplasty? (photos)

Question

Hello, My under eye fat pads have started bulging out in the last two years and it bothers me. Based on these photos, am I a candidate for lower blepharoplasty, or is it not yet indicated? If I am not a candidate would fillers be an option? Thank you

Mehryar (Ray) Taban, MD, FACS · Answer

Yes you do appear to be candidate for scarless lower blepharoplasty but best to have personal evaluation to determine. Also study various techniques for lower blepharoplasty and understand why the gold standard is transconjunctival lower blepharoplasty with eye fat bags repositioning.

Nima Shemirani, MD · Answer

Hi @jessica1993. Thank you for sending your photos-- you would be a great candidate for a transconjunctival lower blepharoplasty. A lower blepharoplasty will address the herniated fat pads and excess skin under your eyes giving you a more refreshed and rested appearance. Best of luck, Dr. Nima!

Peter Lee, MD, FACS · Answer

Yes, you are an excellent candidate for a transconjunctival blepharoplasty (incision hidden on the inside of the eyelid). Rather than simply remove the fat in your lower eyelid, we will reposition it to soften the depression of the tear trough. We would also perform a lateral canthopexy to provide more structure support to the lower eyelid, which will also improve the contour and lateral sweep of the lower eyelid.

Kaveh Alizadeh, MD, MSc, FACS · Answer

Dear Jessica 1993,
Based on your name, I am guessing you are 29 and although this may seem early for surgery, it is the only way to address the under eye fat pads by gently removing them via a scarless approach called transconjunctival blepharoplasty. You can also use fillers to help soften the transition of the bulge but this is sort of like "sweeping it under the rug" approach and not really treating the excess bulge problem.
Either way make sure you have a board certified plastic surgeon evaluate and treat you.

Sam Speron, MD, FACS · Answer

Thank you for your question and pictures!  By the pictures that you have provided, it seems that you would be a candidate for a lower blepharoplasty.  Horizontal eyelid wrinkles and sagginess can be corrected with blepharoplasty or cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery, but the results will not be as dramatic, nor will it provide permanent solution. However, you can get Botox injections afterwards for maintenance.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

C. Blake Perry, MD · Answer

You are a great candidate for lower lid blepharoplasty. During this surgery fat is removed and repositioned to allow a smooth transition from the lower lid to cheek. The incision is made on the backside of the eyelid without leaving a scar. Best to see an eyelid expert.

Brian K. Machida, MD, FACS · Answer

You are a candidate for a lower blepharoplasty and would probably get a transconjuctival approach. It's best to have a personal consultation.

Marc Polacco, MD · Answer

Thank you for your question. Based on your photographs, is appears that a lower blepharoplasty would be helpful for addressing your concern of lower lid fat pad show. In your case, the fat could be transposed into the tear trough, acting as a permanent filler. Fillers are certainly an option for adding volume to the tear trough region to help smoothen transition from the eyelid to the cheek, however, just note that the fat pads will not be addressed with this method. Hope that helps!
Dr. P

Christopher C. Lo, MD · Answer

Has there been filler placed in the past? Fillers can sometimes draw fluid, which can lead to swelling in the area. If no filler has been placed, there are no allergies or other systemic issues causing the swelling of the lower eyelids, lower blepharoplasty is a great option to remove the lower eyelid fat bags. To distinguish swelling from lower eyelid fat prolapse, it is important to have an in person visit with an Oculofacial Specialist.
Be well,
Christopher Lo, MD

William Portuese, MD · Answer

From the photographs presented,  you have herniated fat pads in the lower lids. A trans conjunctival lower eyelid blepharoplasty can accomplish removal of those fat bags with all incisions placed on the inside of the eyelid. No external incisions are required.