Puffy and discolored under eye bags: am I a good candidate for lower blepharoplasty? (photos)

Question

I'm a 23 year old female who has struggled with puffy and discolored under eye bags since I was a young child. I consulted a dermatologist about getting fillers when I was 17, but was told I was not a good candidate because my under eyes were already over-filled. He posited that my under eyes looked the way they do because of seasonal allergies and my flat cheeks. So, I'm wondering if lower eyelid surgery would help as opposed to fillers.

Donald B. Yoo, MD, FACS · Answer

Common reasons for lower blepharoplasty include tear trough deformity or pseudoherniation of the orbital fat. An in-person exam would provide a more accurate diagnosis, but preliminarily based on your photos it does appear you have pseudoherniation of fat creating "eye bags.” They should also be more prominent when you look up. Transconjunctival lower blepharoplasty with fat repositioning will provide nice results and a better lid-cheek transition in this case. @drdonyoo

Nima Shemirani, MD · Answer

Hi @lunascorpio. Based on your photos, you would be a great candidate for a lower lid blepharoplasty. Common reasons for lower blepharoplasty include pseudoherniation of the orbital fat pads and tear trough deformity. Best of luck!

Sam Speron, MD, FACS · Answer

Thank you for your question and pictures!  Horizontal eyelid wrinkles and sogginess 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. Of course, there are also many combinations.

A mini facelift or midface lift is another great option for many people to correct malar bags and other signs of aging around the eyelids. The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day, you can shower the next day, there are  no scars behind the ears and you can wear your hair up anytime and most patients take no pain medicine. There are never any guarantees of course with any procedure whether it is surgical or nonsurgical in nature.

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.

James R. Gordon, MD, FACS, FAAO · Answer

Thanks for sharing your question and posting your photos. You could improve the puffiness of the lower eyelids with blepharoplasty, but the dark skin will remain. The darkness appears to be from fine blood vessels immediately beneath the skin. These do kit get removed with surgery. Make an appointment with an experienced oculoplastic surgeon for comprehensive evaluation and discussion of potential treatment options. Good luck!

Nelson Lee Novick, MD · Answer

Since the upper cheek area is a major physical support for the infraorbital region, volume deficit (as evidenced by the "flat cheeks") in this area constitutes a major reason for the the developement or worsening of the under eye bags, tear troughs, hollows and dark circles. The use of a robust HA filler appropriate injected into the upper cheek region can help to minimize this and would also, at the same time, provide the necessary volume to create a more heart-shaped, oval face--a kind of two for the price of one benefit. Be sure to consult with an experienced, board certified cosmetic dermatologist and ask to see his/her personal before and after photos before agreeing to proceed. Best of luck.

Mehryar (Ray) Taban, MD, FACS · Answer

Yes you do appear to be candidate for lower blepharoplast pending more detailed evaluation. Technique is important to achieve natural results. See an expert.

Alan Gonzalez, MD, FACS · Answer

Hello @lunarscorpio thank you for your question. Yes you are candidate. There is excess of volumen in the lower eyelid, a transconjunctival lower blepharoplasty is indicated to improve the area without generating descent in the eyelid margin. For more information and recommendations it is best to consult with one or several board certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Marc Polacco, MD · Answer

Thank you for your question. Allergies could certainly be a contribution, and I would try to address that first. However, most likely a lower blepharoplasty would be helpful in obtaining a smoother transition from the eyelid to the cheek. Lower eyelid prominence is caused by fat pads under the eye. During surgery, these fat pads are reduced in size or moved to fill the tear trough, depending on the surgeon. While fillers could help fill the tear trough, they wouldn't be able to address the prominence of the fat pads. All the best!
-Dr. P

Andrew Miller, MD · Answer

Many people can have an inherited appearance of bags under the eye, even when young. Lower lid blepharoplasty can do a great job of reducing the fat which also removes the shadow effect. Be sure to see a facial specialist for consultation.

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 hyaluronic acid fillers like Restylane, long-lasting micro-fat grafts, blepharoplasties, or combinations of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result. The darkness may be less obvious, but will not be totally eliminated.

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). You should discuss your concerns with that surgeon in person.