Help 42 and I need work but I don't know what will help me! What can I do for my eyes please? (photos)

My under eyes are so bad and I don't know what to do. The lines are terrible. I can't wear foundation or concealer as it seems to make them stand out even more. I'm 42 but feel like I look much older. What are you options on what I need? Thanks!

Doctor Answers 8

Loss of volume of the tear trough and upper cheek area.

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Hi smr9673,

I agree with Dr. Steinsapir.  Please read his response. Of note, he is an experienced occuloplastic surgeon (eyelid plastic surgeon with ophthalmology training)  You have significant hollowing of your lower eyelids as well as upper cheek.  Only treating the lower eyelids without adding volume to the upper cheek would not give the full effect you may be looking for.

I suspect that your upper eyelids do not actually look like the selfie you posted.  Some people will do funny things to strain to their eyes when taking photos.  This may be the reason we don't see any upper eyelid platform.  I also suspect that when compared to your younger photos, you probably did not have much upper eyelid showing even back then (Think Jennifer Aniston vs. Courtney Cox.)  So I will not comment on whether or not you would benefit from upper eyelid surgery.  Additionally, you did not say that your upper eyelids bothered you.

I think the aesthetic goal for you would be to make your cheek and lower eyelid appear to be one single smooth surface.  Please check my web reference as an example.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

It is important to understand that you are not an ideal candidate for eyelid surgery.

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Don't let any one blow smoke your way.  That does not mean you can't have help.  It needs to be done thoughtfully and carefully.  You will not do well with the "blue plate special."  For the lower eyelid, you have significant mid face laxity not just a lower eyelid issue.  You are missing buccal fat that would normally support the cheek.  There are surgeries that can support and lift the mid face.  I also think you might do great with reinflation of the mid face using hyaluronic acid fillers.  You have very active forehead lines. In the photograph your eyes are very open.  However, this one photo may or may not be an accurate representation of the how you carry your relaxed face.  A very conservative upper blepharoplasty to create a small area on the upper eyelid platform for make up can be very powerful.  When you get consultations, listen very carefully to what is being told to you.  If the surgeon tells you what you need without a detailed examination including touching and manipulating the eyelids and mid face, you are probably in the wrong office.  Please consider reposting on RealSelf to let us know what you learn.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eyelids and midface

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As many have stated, pictures alone really can't accurately depict your situation. You really need to be examined in person by an experienced oculofacial specialist.
I would agree that the majority of your aging changes are due to changes at the junction of the lower lid and midface and volumizing this area with hyaluronic acid fillers would certainly be a safe and potentially very effective initial treatment. Laser resurfacing could also be beneficial to give some tightening effect to the lower lid skin. While a conservative upper blepharoplasty might also be an option, it might be best to start with non-surgical approaches. But again, these are all things that you would need to discuss in-person with a surgeon experienced in this area.

Kenneth E. Morgenstern, MD
Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews


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I always like to start with the most conservative approach. I think you would see significant benefit from filler in the under eye and upper cheek area. Schedule a consultation with a board certified plastic surgeon in your area who can assess you in person and discuss the best options. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Lower lid blepharoplasty

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A lower lid blepharoplasty in which bulging fat is removed and repositioned along the tear trough and a conservative amount of skin is removed along your eyelash border would give you a nice result.  An upper lid bleph would be also a nice touch. 

Best options for eyelid rejuvenation

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Thank you for your inquiry.  It is sometimes difficult to make a treatment recommendation without knowing what a patients ultimate goal is.  Review of old photographs can sometimes be extraordinarily helpful.  A combination of surgical and nonsurgical approaches (possibly including laser) may

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 43 reviews

A Perfect Patient for Cosmetic Rejuvenation

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Thank you for sharing your photos and case.  You seem to be a perfect candidate for cosmetic rejuvenation of the eyes and face.  Upper blepharoplasty will remove the excess heavy skin from above your eyes and lower blepharoplasty will remove the bags and worn appearance underneath.  Botox or xeomin can be used to relax the worry lines and sun damage in your forehead.  Schedule a consultation with a board certified cosmetic surgeon whom you trust to begin the discussion.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.9 out of 5 stars 38 reviews

You need both upper and lower eyelid blepharoplasty

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from these photos, I believe you would really benefit from upper and lower eyelid blepharoplasty. I would also recommend to star using some type of neuromodulators like Botox. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.