What Tx Recommended for Eyes with Puffy Bags & Wrinkles? Will Tattoo Eyeliner Be Cut Off? (photo)

What tx recommended for eyes with folds, puffy bags underneath Will surgery cut off the permanent eyeliner above and below? What can I do about upper eyes which didn't heal properly from 1996 surgery?

upper eyes done in 1996; left eye doesn't droop but is more upper eye worth cost as plan for lower face & neck lift. New concern for recent appearance of folds & bags WHEN I SMILE! Catch 22; when I don't smile, lips are downturned and look sad combined with puffy marionette lines each side. Dermatologist suggested various skin tightening ie: laser, Pelleve, thermage & botox but wouldn't a surgeon prefer blank slate? Will permanent eyeliner be cut off with blepharoplasty?

Updated: January 25, 2012

Doctor Answers 1

Correcting eye hollowness with fat grafting

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Lower lid hollowness can be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.

One of the most remarkable and rewarding enhancements I have been able to provide patients with fat grafting is the creation or restoration of soft tissue fullness in the interval between the upper lid crease and the eyebrow. I refer to this location as the 'brow-upper lid junction'. Hollowness in this area projects an image of advancing age, or exhaustion, or illness - and sometimes all of the above. Fullness in this area projects a sense of youth and vitality. Just look at the 20-something models you see in fashion magazines; in almost all of them you'll find that the upper lid is mostly or completely concealed by the soft tissue fullness immediately below the brow.

Raleigh-Durham Plastic Surgeon
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