Botox/upper bleph for 20 year old?

Recently my thinned skinned 20 year old daughter consulted regarding the dark circles under her eyes. We did not inquire about this, but she was told that her crows feet are consistent with a 25 year old, would be a candidate for botox, and her upper lids were too heavy giving her a tired look. Although I agree with the findings, and I had those procedures done when I was in my 30's, I feel 20 is WAY too young. However, a can of worms has been opened, and now she is self conscious. Thoughts?

Doctor Answers 13

Blepharoplasty for someone in their 20s

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I can certainly understand her concern.  I would say someone in their 20s and is very young for blepharoplasty but without an examination I could not say for sure.  Certainly in my career I have seen people genetically or anatomically have lids so heavy that it actually impairs her vision necessitating some sort of conservative blepharoplasty.  If she is thin skinned and prone to wrinkles and a conservative amount of Botox would not be unsafe or inappropriate.

I would get more than a few consultations with people who specialize in eyelid surgery in particular an oculoplastic surgeon or even an ophthalmologist first.  He wanted to ensure that there is not a medical condition present that is contributing to her appearance.  In some of these cases surgery could actually worsen the condition.

please move forward cautiously

Chase Lay, MD
Double board-certified facial plastic surgeon

Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

These services can be appropriate or they can be harmful.

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It all depends on how it is done.  Very commonly upper eyelid surgery is performed in a very aggressive manner.  The individual has all of the upper eyelid fold removed, too much fat and the motor nerves to the upper eyelid orbicularis are harmed by the surgery making it difficult to blink.  This can even give a 20 year old a dry eye.  

You did not supply any photographs so I can't be concrete with regard to recommendations.  Generally what a 20 year old needs for an upper blepharoplasty should be very subtle.  There may be a small degree of upper eyelid ptosis and lash ptosis that should be corrected.  It is critical to preserve the upper eyelid fold.  These needs can be met with a very thoughtful and detailed micro-anchor blepharoplasty.  The link below on my website has several examples of this type of surgery.

Botox and fillers are actually a fantastic options but with this proviso:  The services are not commodities.  Who does the service and precisely how the service is done makes a critical difference.  Even without seeing pictures of your 20 year old, it is highly likely that microdroplet botox forehead lift and expertly performed under eye fillers can replace the need for any surgery for many, many years.  Please choose wisely and don't get bullied into  service that is not right.  

Please be careful with the consultations, many office prey of weak self-esteem as a way of coercing potential patients into having surgery ( "You have the eyelids of a 25-year old," is a deadly curse to a 20-year old).  This can be a very corrosive process for a vulnerable 20-year old.  Sometimes not so signifiant cosmetic issues become the focus of what is really a self-esteem or adjustment issue.  It often seems easier to have a surgery rather than deal with the underlying emotional issues.  If that is the case, she might benefit from working with a psychologist which can help strengthen her emotionally.

Finally, remember that fillers and botox are reversible but surgery is not.

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

20 year old blepharoplasty

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20 years old does seem young for a blepharoplasy, however, without pictures and a thorough examination, it is challenging to comment. Genetics can play a large role in the anatomy of the eyelids, especially the heaviness of the upper eyelid. If the heaviness is impairing the vision of the 20 year old, I would take her to an oculoplastic surgeon to have a complete examination. At our practice, we’re seeing an increase in patients in their 20s starting to have BOTOX injections as a preventative measure. If they are just now seeing the fine lines and wrinkles, BOTOX can relax those muscles and keep them inactive, therefore potentially limiting the creation of further wrinkles in the future.

William P. Mack, MD, PA
Tampa Oculoplastic Surgeon
5.0 out of 5 stars 46 reviews

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A conservative approach might be wiser

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Naturally, it is difficult to answer this question without seeing your daughter or, at least photos of her. In general, I would agree with you that 20 if awfully young to consider surgery and I agree with Dr. Steinsapir that if surgery is considered, a most conservative procedure would be best. Since I am in St. Petersburg, please let me know if I can be of help. Good luck!

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 140 reviews

Eyelid surgery at 20 year old seems too young

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I would think that age 20 is young for upper eyelid surgery unless there is an inherited condition which leads to very heavy eyelids. It is likely that there are a number of nonsurgical alternatives if there are really concerns such as fractional laser resurfacing or ultrasound assisted browlifting with Ulthera. Botox, depending on the degree of solar skin damage, is not totaly out of the question. I would suggest starting with healthy skin practices such as sun protectants and antioxidants is the best thing.

Arthur N. Falk, MD
Albany Facial Plastic Surgeon

Botox/upper bleph for 20 year old?

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20 is generally far too young to undergo a blepharoplasty.

Keep in mind that following the advice from a surgeon on this or any other website who proposes to tell you exactly what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Botox/upper bleph for 20 year old?

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20 years of age is far too young to consider a blepharoplasty, it would be helpful providing photos but I suggest you seek a qualified physician for a second opinion 

20 years old is too young for a blepharoplasty, see a different doctor

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Thank you for your question.  Most reputable plastic surgeons address the specific problem that the patient is consulting for and do not call attention to other unrelated problems.  In my opinion your plastic surgeon did a disc service to your daughter and her self-conscious feeling is a direct result of care looseness on the part of your surgeon.

Please read the link below for the medical causes of dark circles under the eyes and the various treatment options available.

Please see another plastic surgeon,  Experienced in eyelid surgery, and who has an excellent reputation in your community

Upper eyelid surgery for a twenty year old

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Twenty five is very young for a blepharoplasty. I can't say it is inappropriate without an exam, but it certainly unusual. She may have a medical condition, like blepharoptosis, that would make surgery appropriate but I suggest a second opinion in case the first was overly aggressive.

Daryl K. Hoffman, MD
San Jose Plastic Surgeon
4.7 out of 5 stars 18 reviews

Blepharoplasty for a 20 year old?

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I agree that 20 seems a bit young for a blepharoplasty.  If you have doubts about the information you have been given, I suggest you seek a second opinion.

Gilbert Lee, MD
San Diego Plastic Surgeon
4.6 out of 5 stars 25 reviews

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.