I am considering an upper & lower bleph. Mother had puckering on lower. Who is a good candidate for a lower done with laser/TCA?

I have mostly sagging, very little fat. Also considering brow lift, and something to deal with jowl. Surgeon said I could get good results with TCA for lower lids. What is general opinion of this, and what is the recovery. Given I am 47, and not wealthy, what is the biggest bang for the buck I can get. Not sure I can afford the time or $ for all. Lastly could you comment on lifestyle type lifts? I'm in Boston. I' having a hard time sorting through all the docs here. Any suggestions?

Doctor Answers 5

Lower Eyelid Rejuvenation

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The most common age women come into our office for a first rejuvenation procedure is 43, and the most common procedure is a blepharoplasty. Of course I would need to examine you to know for sure, but it looks like your best "bang for the buck" would be an upper and lower eyelid blepharoplasty with a laser resurfacing of the lower eyelids. From your photos I do not believe your brows are low enough to warrant a brow lift. An upper eyelid blepharoplasty removes some of the excess skin from your upper lids. The fullness of your lower lids is from the fat of the lower lids pushing through the membrane that holds them in place. This and the loss of volume in your upper cheeks leads to what we call a tear trough. The fat of the lower lids could be moved into the tear troughs and the outer depressions of your lower lids. It creates a more youthful line from the lid to the cheek. A carbon dioxide laser resurfacing of the lower lids at the same time will tighten the skin, which you also seem to need. I have given you a link below and would be happy to see you.

Upper and lower eyelid blepharoplasty

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The primary goal of upper lid blepharoplasty is to remove excess skin, and a small amount of fat on the inner corner.The incision is located in the upper eyelid crease. The primary goal of lower lid blepharoplasty is to remove a portion the 3 fat pads creating a puffy look. The incision is in the inside of the lower lid also known as a trans-conjunctival approach. The secondary goal of lower blepharoplasty is to tighten up excess lower lid skin. There are a combination of techniques to remove excess skin including the pinch technique which we use most frequently, fractionated laser treatment and chemical peel. For many examples, please see the link below

Treatment for Early Aging Changes of the Face

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Before you undergo any procedure you deserve an accurate diagnosis. In the world of facial aesthetics that means understanding your anatomy and aging related changes that occurred over the years. In your situation, multiple factors come into play:

  1. Sagging of the brows, lids and lower face/neck
  2. Volume loss of the face including deflation of the junction between lower lid and cheeks, temples, sides of the chin etc.
  3. Muscle hyperactivity primarily reflected in creases of the forehead, between the brows and "crow's feet"
  4. Sun induced skin changes.

Best and most balanced rejuvenation results will be provided if all of these changes are addressed in a meaningful way. Because you are young, none is especially advanced or dramatic. Keep in mind that a peel will not address the under-eye hollowness where shadow effects lead to the dark circles - adding volume by using your own fat will be important.

Advertising as performed by Lifestyle Lift or "only such and such a doctor should do your surgery" are effective to get "consumers" in. Knowledgeable patients understand that it is the particular doctor with his/her experience and aesthetic vision who will be responsible for the care and outcome, not a company, hospital or membership in a particular organization.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 51 reviews

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Best bang for the buck

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Based on your photos, I think the best bang for your buck to make you look less tired would be to concentrate on your upper face. I would recommend upper eyelid surgery along with filler injections into the lower eyelids to help blend the eyelid-cheek junction. This would rejuventate your eye area and make you look less tired. You could always have a face lift at a later date when you have a larger budget.

Laser or TCA Peel can address Lower Eyelid Wrinkles

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Your Lower Eyelid displays asymmetry, skin laxity and wrinkles, Bulging fat and descent of the malar fat pat and a gentle midface droop. TCA and Laser will address the skin wrinkles but not the others. If you have Lower Lid Laxity ( this can be determined by your Plastic Surgeon at the time of your consultation) then TCA/LASER should be combined with a Canthopexy to tighten the corners otherwise you can end up with problems such as ectropion or excessive exposure of the eye. If the bulging fat and drooping midface is a concern then you will need surgery to reverse the changes.

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.