Unbelievable bags under my eyes. Lower Bleph or Facelift or..? (photos)

When younger, I always had deep hollows & the purple veins also showed thru my thin skin. Bags started around age 40. They swell some days more than others, but are ever-present. Had an upper bleph 3 years ago and love the results, but lower bleph scares me. Also have jowls and marionette lines now. When I pull my face skin up, it also reduces my bags if I do it just right! Would a facelift be the way to go, or just a lower bleph, or a combo? What approach would you recommend? Seems tricky.

Doctor Answers 6

The importance of choosing an eyelid surgical specialist, and why a facelift is a separate procedure

As a cosmetic oculofacial surgeon specializing in facial aging surgery for 20 years, I do a lot of lower and upper eyelid surgery as well as face and neck lifts. First, let’s understand that the lower and upper eyelids are in a very unique space called the orbit. Although you can physically move everything, which we call the mirror lift, it may look better but it is not in a level that is sustainable when you do aggressive face lifting. Lower eyelid surgery and face lifting procedure are two separate procedures. Although there may be some secondary benefit to the lower eyelid by repositioning the cheek as occurs in a facelift, trying to change the lower eyelid position, tone and overall appearance from a face lifting procedure will not likely be successful.

The lower eyelid is a very complex structure. As a specialist, I deal with patients from all over the world, where they had lower eyelid surgery by board certified plastic surgeons and they have had severe lower eyelid retraction, skin loss, exposure and their lower eyelid was disconnected from their outer corners. Lower eyelid anatomy is complex and sometimes surgeons who don’t have specialized training will get themselves in trouble. The lower eyelid tone and position is so critical - it is important point in your decision-making process when you meet with prospective doctors in choosing who to do your lower eyelid surgery.

Very often, we will combine the lower eyelid surgery with the face and neck lift surgery. When you meet with a doctor, the way to understand if the doctor is at a mastery level of the lower eyelid surgery is by doing various tests to check the tone of the lower eyelid, such as a pull test or a snap test. With that, there are options on how to ensure that the lower eyelid position is maintained or enhanced with procedures such as lateral tarsal strip. When you are doing your consultations, you may decide whether to do the procedures together or to do them separately. With your level of anxiety it might be practical to do the lower eyelids first to make sure everything turns out right.

In our practice, we don’t use general anesthesia routinely for any procedure. We do everything in local LITE sedation™. By doing that, our patients can make decisions based on their own comfort rather than the incentive to do as much as you can while going under general anesthesia.

Learn more about your situation and meet with qualified experienced cosmetic surgeons about your lower eyelids, facelifts and neck lifts. Once you feel comfortable, move forward and have these procedures done. I hope that was helpful, I wish you the best of luck, and thank you for question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Blepharoplasty may make your festoons look worse

Based on your photographs I believe the puffiness below your lower eyelids are festoons or malar bags.  If I am correct then a lower blepharoplasty will accentuate the festoons and make them look worse.  Please consult an expert board certified plastic surgeon who is experienced at oculoplastic surgery for an examination and evaluation.

Lower Bleph or Facelift?

Hello and thank you for your question.
Although your photos are limited, it looks as though you would benefit from a face/neck lift. In addition, upper and lower blepharoplasty. However, you have festoons which are difficult to treat. For a more thorough discussion regarding this, I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.
Best of luck to you!

David L. Cangello, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 14 reviews

Facelift and lower blepharoplasty

Thank you for your question.  Reviewing your photos, I would say that you seem to have a good grasp of your facial structures.  One clarification I would like to make is that a facelift is really a lower face and necklift.  This would not address your lower eyes.  To address both areas, you would need both procedures.  I would temper your expectations for the lower lids because of the presence of festooning (the more prominent swelling just below the lower eyelid).  These are not an easy problem to deal with and a standard lower blepharoplasty is unlikely to make these go away entirely.  There are options for festoons, but none of them are perfect for every patient.  As always, its best to see a surgeon who is well respected and performs all the procedures you are considering.  A hands-on, in-person consultation is likely to be the best and most informative option to find someone you have confidence in and a good rapport with.

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

I don't thin you are going to be happy with just a face lift or just a lower eyelid surgery.

Sometime it makes a lot of sense to have more than one procedure.  Carefully do your homework.  Surgery should be natural, not be life threatening, and not cause complications.  That is easier said than done.  Finding the right surgeon is a huge challenge.  If you see a doctor and it does not feel right, move on.  Listen to your feelings about this.  Remember cosmetic surgery is not a necessity.  Take you time. 

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

Facelift and lower eyelid bleph

You have some lower facial heaviness with marionette lines, jowls, and some neck fat.  You would benefit from neck liposuction, probable platysmaplasty, and facelift.  The lower eyelids show some festooning.  A lower eyelid bleph can help with this, but it can be very difficult to eliminate the festoons in some patients.  With the bleph and some laser resurfacing you can usually tighten this skin up to make it look smoother.   In the side photo it looks like you outer brow is low causing some extra skin folds of the lid.  You would benefit from a temporal browlift.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 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.