Would Lower Blephoplasty Be my Answer? (photo)

61 yrs/old, very thin and considering lower Blephoplasty . Two consults with Plastic Surgeons, both stating they would remove the fat pad with an incision along the lower lash line. My concern is, because my face is thin, will I look hollowed out? Would injections be a better option? I'm having breast explantation and thought I could have the Blephoplasty done at the same time. Now I'm reading some bad results with scars, healing properly etc... Any advice would be appreciated!

Doctor Answers 24

Dont put fillers there

I think fillers look terrible in the tear troughs --- you would do better with a lower lid belpharoplasty.

New York Plastic Surgeon
4.1 out of 5 stars 11 reviews

Lower blepharoplasty vs filler injections

The posts here show that different doctors will have different opinions on what to do. I think that the main problem is descent and hollowing of the upper cheeks, which makes the mild amount of excess fat in the lower eyelids much more visible. I feel that a standard lower blepharoplasty with removal of fat alone would only make this condition worse and make your face look even more thin.

I find it hard to tell exactly how much excess fat is present in your lower eyelids from the photos you sent. Based on what I see, I would probably recommend filler injections to both the upper cheeks and tear trough area to blend the eyelid-cheek junction and create the appearance of having a higher cheek bone.

I would recommending getting another 1-2 opinions and then going with whoever you feel the most comfortable with. Best of luck.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 145 reviews

Would Lower Blephoplasty Be my Answer?

 I have performed Lower Blepharoplasty from inside the lower eyelid for over 23 years and believ that be a superior technique.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Lower bleph with fat repositioning

It looks like many of the doctors on this thread have the same idea... lower bleph with fat repositioning. Removing the fat pad will just create a more hollowed out look. You will need to have the fat repositioned to create more volume, volume is what you need.

Joel Aronowitz, MD
Los Angeles Plastic Surgeon
3.4 out of 5 stars 9 reviews

Improving Lower Eyelids

A lower eyelid blepharoplasty is performed to smooth out the contour of the lower eyelids and reduce skin wrinkling.  Your "puffy bags" are due to protruding fat and could be corrected by either removing and/or repositioning some of the fat in an effort to fill in the "tear trough" groove just below the fat.  This surgery, although not without risks, usually heals very well without any visible scars.  Alternatively, filler or fat injections into the tear trough could fill this area up to a certain degree, which would help the area blend into the puffy fat in a less visible manner.  However, with a significant difference in level between the 2 areas and with a lot of protruding fat, it seems to me that you would achieve a better, longer-lasting resuslt with a blepharoplasty.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 24 reviews

Lower eyelid fat can be repositioned instead of removed.


You are right to worry about looking hollow.  But you  may be past the point of treatment with injections.  Skillful surgery will help you, either by repositioning fat or with fat transfer.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Midface volume restoration your first step

If you start by re- filling the volume lost in your mid face (the area below your lower lid/cheek crease and the nasolabial fold, you will correct at least 70-80% of your problem. My favorite volume is your own fat but any of the fillers available will do. I believe you can get great results using Restylane along your tear trough. I use Juvederm everywhere else. After volumes have been restored then you can determine if a surgical approach such as a blepharoplasty is needed.

If you want to know how much volume has been lost, pull out your high school graduation photo. It will amaze you.

Manuel M. Pena, MD
Naples Plastic Surgeon
4.0 out of 5 stars 4 reviews

Hollowed Out

Bleph alone without addressing the mdiface volume loss would likely result in a less than optimal result. You need more than a lower bleph.  Fat transfer would be a useful adjunct.   All the best.

Rejuvenation of the lower eyelid zone and achieving a youthful appearance

There are many factors that you should consider when contemplating rejuvenation of the lower eyelid area.  The problems that you have include a thinning of the lower eyelid skin with a descent of the lower eyelid / cheek junction., there is a skeletonization of the peri-orbital area and a looseness of the lower eyelid itself.  A surgical procedure to correct this area is more than just fat removal in fact fat removal will make your condition worse and just hollow you out.  To rejuvenate this area I would recommend an external lower eyelid subcillary incision, a separate skin and muscle flap, a repositioning of the lower eyelid fat to fill in the hollowed out areas, a suspension of the muscle, a tightening of the lower lateral canthal tendon and a cantholysis and canthopexy.  All of these procedures would be directed at restoring volume, this is how to achieve a youthful appearance.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

Lower lid options

A blepharoplasty can certain do wonders for your trough... but as you have already seen, there are so many opinions out there.  I dislike removing fat because your eyes tend to become more hollow as you age.  That being said, I prefer to move the prominent fat in the pad into the trough to smooth out your lower lids.  You can either laser the skin or have a pinch skin excision.  You could ask your surgeon WHY they recommend the procedure they do and bring up the alternatives for their opinions as your exam may have revealed something that makes their approach the best.  But if its 'thats how I do it', then I would find another surgeon.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

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