Lower blepharoplasty with negative vector (Photo)

Question

I have a negative vector face shape and hereditary eye bags. I am desperate to get lower blapharoplasty however my face shape makes me at higher risk of eyelid retraction as my cheek bones don’t provide the normal level of support under eyes. Additional support may be provided in the form of filler, implant or fat transfer. The latter two seem very risky and come with their own issues. Should I be advised to stay away from bleph altogether, or is there a way of performing this successfully?

C. Blake Perry, MD · Answer

You are still a great candidate for a thoughtful lower lid blepharoplasty. You will need an in person exam to determine the appropriate surgical approach. Best to see an eyelid expert.

Mats Hagstrom, MD (license on probation) · Answer

This anatomic area is complex and not always easy or straightforward for either making assessments or treatment.
With typical facial aging, there are two reversing volume changes that happen immediately adjacent to each other.
In a youthful face, the lower eyelid is snug with no bulging of the lower eyelid fat pads.In the mid face starting to tear trough region the opposite happens. The area begins to lose volume and descent due to gravity.
Most individuals will have both loss of volume in the mid phase with immediately adjacent, excessive volume in the lower eyelids.
Sometimes a mid face volume deficit is the primary problem, and sometimes the protrusion of the lower eyelid fat pads that the weakness in the Peri orbital septum is primary.
And some individuals the problem is almost exclusively, a lower eyelid problem, and for others, it can be primarily midface volume loss. for most patients, it’s a combination of both.
Removing volume in the lower eyelids is fairly straightforward. It is probably the easier of the two procedures. It’s best diner with a trans conjunctival blepharoplasty. 
Restoring midface volume is complex and not always easy or straightforward. In the hands of inexperienced providers, the results can often end up being different than what both patient and provider had hoped for.
Mid face volume restoration can be done, using fillers, fat grafting, implants, or with the use of a mid facelift(very different than a traditional facelift).
The predisposition, for this condition is highly dependent on bone structure, especially an individuals lacking strong anterior projection of their maxilla. 
If you consult with different providers, you will hear different opinions regarding how this is best at treated. Obviously, if you consult with providers who have an incomplete tool basket such as nurse injector you’ll get a one-sided response. 
It’s important to get assessed by providers who can treat both conditions and have experience in doing so. Sometimes treating both problem in a more conservative way and gives the ultimate outcome.
Being overly aggressive in any one of the two treatment options can lead to unfavorable long-term outcomes.
To get an understanding of what volume restoration alone can accomplish I suggest you take a look at the website of Dr. David Mabrie MD in San Francisco. His work using fillers for volume restoration. If some of the best I’ve ever seen, and I consider his work to be the gold standard, and what can be accomplished using only fillers.
I’m not suggesting everybody travel to San Francisco to get fillers done, but seeing what can be done with this treatment conserved as an understanding of what cameo came, and this can be used for comparison when interviewing other providers.
Trading this anatomic area is not always easy or straightforward and this includes not only the technical part of surgical intervention maybe even making an assessment asked to differentiating primary versus secondary problems.
Whenever something is not straightforward and complex, expect different providers to have slightly different recommendations on how to approach the situation. In some cases where the primary problem is almost exclusively, the issue providers will be more consistent in the recommendation. When both problems exist in a relatively equal manner, whether the lower eyelids or the mid face is more important, sitcoms a little more tricky. Finding the right provider is in the end, the absolute most important variable. This is potentially even more important than which procedure they choose.
The following are some general guidelines for finding the right provider for those seeking cosmetic surgery.
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 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 look like or what your results are likely to be 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 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

Lower blepharoplasty with negative vector (Photo)

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