I have had tired looking eyes since childhood, will a lower Blepharoplasty help? (photos)

I have had dark circles since I was a child and have been told that I look tired since my teens. I can remember at 14 yrs of age tilting my head up a bit in photos so that the dark "valley" wouldn't appear as noticeable. As I get older (44 yrs), the situation only gets worse. I read that dark circles are usually hereditary, though no one else in my family is plagued with these. Will a lower bleph be enough, or do I need fat, filler or tear trough implants? Many thanks for your time.

Doctor Answers 11

Lower lid bulges

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  • Your problem appears to be from prominent lower lid fat -that typically appears early on.
  • I do not like fillers because the results are unpredictable and temporary - but
  • a reasonable choice if you have not time for surgery.
  • A lower lid blepharoplasty, carefully done to redrape the fat, trim any excess and do any subtle fat grafting if needed should give you a nice result.

Tired looking eyes - fillers or blepharoplasty?

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Fillers often can produce a nice temporary cosmetic improvement in some patients, but not all. They certainly do not achieve what a well performed blepharoplasty will do.

Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservatively removing any excess loose skin that may be present, contouring the bulging fat pads, which are generally inherited, unrelated to weight, and tend to protrude more with time, and smoothing the tear troughs with micro-fat grafts or fat repositioning.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do based on two dimensional photos without examining you, physically feeling your 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 surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is 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, M.D., FACS

La Jolla,California

Filler or lower blepharoplasty

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You can benefit from either filler injection to fill the hollowness ("dark circles") or possible from lower blepharoplasty with fat transposition where the fat/bulge is moved into the hollow area.  See an oculoplastic specialist.

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I would assess these recommendations with a grain of salt.

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Lower eyelid bags can be made by a variety of tissue relationships.  So without a physical examination, it would be hard to know if what you need is a lower blepharoplasty.  For some people, that fullness could be caused by the bony orbital rim.  Put your finger on the top of the bump.  If it is soft, it is fat, if it is hard, then it is the bony rim. Obviously what makes the bump makes a difference regarding which surgery to perform.  Fat, yes is nicely helped with an transconjunctival lower eyelid procedure where the fat is mobilized to fill the under eye hollow.  This is called an acus marginalis  release.  Be aware, you could also have a lower eyelid filler with restylane and have the hollow filled without the need for surgery.  This type of service lasts for about 1 year at a time.

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

I have had tired looking eyes since childhood, will a lower Blepharoplasty help?

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Yes, you do have fat pockets in the lower eyes.  This can be corrected with a lower blephroplasty.  The incisions are made on the inside of the eyelid so there will be no incision on the outside of your eye.   

Lower lid blepharoplasty with ffat transposition for tired looking eyes.

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Lower lid blepharoplasty with ffat transposition for tired looking eyes. Patients are extremely happy to have the excess fat placed in the tear trough. This can be done trans- conjunctively  so you have no external scar. See a very experienced surgeon for this.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

I have had tired looking eyes

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Thanks for the great photos. It looks like there is not a lot of lower lid skin excess, but prominent fad pads causing a deep shadowed groove (a tear trough) below the fat. Transposition of the fat into the tear trough would help, but you have such a negative vector that I might be more inclined to consider fat grafting. This is very tricky in the lower lid area so see someone experienced in the procedure if you want to explore that option.

Lower blepharoplasty with fat repositioning

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Your lower lids show fat coming forward from the eye socket. This is common and can be repaired with a lower eyelid blepharoplasty with fat repositioning.  The fat can be moved in to the tear trough, which will smooth out the transition between the lower eyelid and the cheek as well as fill in the dark area near the side of the nose.  

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

Eyelid bags

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You have some prolapsed orbital fat which creates a shadow over the tear trough so it looks dark.  I would not remove this fat as it can make the area more hollow.  You could have a fat repositioning surgery to move the fat down into the tear trough.  However I don't think that you really look that bad - and some filler into the tear trough should help quite a bit and let you postpone surgery.    

Lower blepharoplasty for eye bags

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The photograph shows herniated fat pads in all 3 compartments of the lower lids. This is best addressed with a conservative fat removal  through a trans-conjunctival approach on the inside of the lower lids. For many examples, please see the link below

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.