Thermage or Blepharoplasty for Sagging Under Eyes?

Dear SR
A lot depends on exactly what your issues are. Thermage might make a modest difference but it is not going to correct fullness from herniated orbital fat, it will not get rid of significant lower eyelid wrinkles. If you issue is just a few lower eyelid lines it might benefit the appearance of the lower eyelid skin but if you are looking for surgical results, then it is very likely you will be disappointed with the results of thermage.

if your eyelid bags are fluid cavities, then nothing may work. If they are composed of fat then blepharoplasty is beter. if there is loose skin, thermage might work every well.

 It all really depends on your anatomy.  There is not a single procedure or instrument that is appropriate for all patients.  If you provide pictures we may be able to give you more specific advice.  Good luck with your procedure/surgery.  

Dear SR, the device or procedure you choose really depends on what your goals are. Thermage will give some improvement to the lower eyelids- improved texture and tone of the skin, moderate to very good improvement of the upper eyelids and will help elevate the eyebrows if enough pulses are used in the areas.
Eyelid surgery will improve all of the elements- skin, fat bulging, muscle tone and eyelid position- a more complete rejuvenation. Surgery has more downtime but the results will last 5 to 7 years or more.
With Warm Regards,
Trevor M Born MD

Personally, I doubt that Thermage will give you meaningful improvement for lower lid aging. It is the combination of shape and coverage that distinguishes a youthful lower lid region: The transition from cheek to lower lid should be soft and convex, the coverage should be made of smooth skin. If it is only skin that is the concern (which it rarely is), a skin-only blepharoplasty can be entertained. Alternative, skin resurfacing (laser, peel) could be discussed but remember that the treatment has to go deep enough to cause enough skin tightening for fine wrinkles to improve.
Most commonly, volume loss, fat excess and skin wrinkling go hand in hand.
The most important step is the initial analysis of your particular condition. See an experienced facial plastic surgeon for a thorough evaluation which should be followed by a personalized plan.

Dear SR in TX,
Unfortunately, Thermage treatment around the eyes is a problem as anything done inside the orbital rim can possibly cause serious eye injury. Although eye shields can be used during treatment, the risk of corneal scratching and infection make this a poor, but possible choice of, treatment. A blepharoplasty (eye lift) can make dramatic changes, but is still an  invasive surgery. I would suggest seeking a consultation with a skilled Thermage technician who can tell you which treatment is best for you. Hope this helped!
Dr. S

I have been pleased with Thermage for minimal skin laxity. That is why patient selection is most critical. If you have a small amount of extra skin either below or above the eyes it will tighten it by one to two millimeters to give a brighter more open eye area.  However if you have extra fat pad deposits or excess skin wrinkling your best bet is investing in a surgical blepharoplasty.

Thermage may work on some areas of the body in some individuals some of the time!! For specific and distinct skin excess, the results may be disappointing. For mildly loose skin or to prevent it, Thermage may be valuable. Lower eylid can be improved with Fraxel, peels or surgery.

Thermage and Blepharoplasty are each good treatments for treating certain types of lower eyelid problems. I think it's generally a false choice to consider one or the other as they tend to address different issues.
Thermage is very effective for providing some degree of improvement in fine lines. If this is the dominant concern regarding her lower eyelids, Thermage may be a good noninvasive choice to consider. Most patients, however, complains of puffiness and bulging of fat and lower eyelids in addition to excess skin. In this situation, no significant improvement be seen with Thermage as it can not improve the bulging fat.
There are still other things to also consider which may be used in conjunction with these procedures. Certain types of fully ablative and fractional laser resurfacing can also provide significant improvements to eyelid contours. Again, however the best type of procedure is highly variable and dependent upon the specific anatomic abnormalities that need to be corrected.
I would suggest you discuss these carefully with your surgeon and be sure that the treatments selected addresses your specific concerns.

Thermage will not fixing sagging lower eyelid skin. The primary goal for a lower blepharoplasty is to remove excess fat bags on the lower lids. If there is excess skin, this is removed through a pinch technique and closed with Histocryl tissue adhesive. There are no sutures placed on the lower lids. Thermage will not get rid of fat bags, and it will not get rid of excess skin. The skin needs to be removed conservatively on the lower lids so as not to change the shape of the eye.