Recommendation for lower eyes? (Photo)

Question

It seems i have hollowness under my eyes. I had a co2 peel in my early 30’s and upper and lower eyelift when i was 34. 7 years later , it doesnt look like they held up and i feel like my eyes are not symmetrical.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. You may benefit from a combination of blepharoplasty and volume-enhancing filler to reduce under-eye hollowness and create a more symmetrical appearance. During blepharoplasty surgery, excess skin can be removed, loose muscles tightened, and fat repositioned to smooth the transition from the lower eyelid to the upper cheek area. If you’re in need of additional volume, grafted fat or hyaluronic acid dermal filler can be used to create a firmer and more supple appearance.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to review your treatment history, discuss your concerns and goals with you, and help you decide on the best course of action.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to review your treatment history, discuss your concerns and goals with you, and help you decide on the best course of action.

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As far as I can see from your photos you have extra skin under your eyes and they loose their fullness. Also your eye corners are very downward. If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation. For more young, fresh, elegant and upward look I can suggest you lower eyelid blepharoplasty, cat eye and fat injection to under your eyes. Best Regards!

Zoran Potparic, MD · Answer

Based on these photosI would recommend transconjuctival lower blepharoplasty. It will take care of tear trough deformity. Addition of small amount offat grafts will further improve periorbital area. In person consultation with a board certified plastic surgeon with experience in these procedures, is recommended. Good luck.

Randal Haworth, MD, FACS · Answer

It's not uncommon for the effects of eyelid surgery to diminish over time, and hollowness under the eyes can be a common side effect of aging. If you're experiencing asymmetry or dissatisfaction with the appearance of your eyes, it may be worth consulting with a board-certified plastic surgeon or oculoplastic surgeon to discuss potential options for revision surgery.

One possible solution for addressing hollowness under the eyes is to use dermal fillers or fat grafting to restore volume and create a smoother, more youthful appearance. Your surgeon can evaluate your individual case and recommend the best approach based on your anatomy, aesthetic goals, and medical history.

In some cases, a revision eyelid surgery may also be necessary to correct asymmetry or other issues with the appearance of the eyes. Your surgeon may recommend additional procedures such as a brow lift, upper or lower eyelid surgery, or other treatments to help achieve a more natural and balanced look.

Ultimately, the best approach will depend on your individual needs and goals, so it's important to work closely with a qualified and experienced plastic surgeon to develop a personalized treatment plan. They can evaluate your situation, discuss your options, and help you make an informed decision about how to move forward.

I hope this helps,
best of luck !

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.

What I am seeing in your photograph appears to be extra or excess skin on the lower eyelids.

This may be the result of a trans-conjunctival lower blepharoplasty without skin excision.

A skin excision blepharoplasty should help but discuss with your surgeon the possible need for a canthopexy.  Secondary blepharoplasties can be at risk for ectropion or downward pulling of the outside of the lower eyelid.  Thus if you do have a skin excision lower blepharoplasty a canthopexy may be required as well.