Am I a candidate for a lower blepharoplasty? (Photo)

Question

I am a healthy, 42 y/o, AA woman who has been self-conscious about under-eye bags for many years. I find that they get worse depending on salt intake and (currently) my seasonal allergies. I was thinking of filler, but heard it could migrate, and I also wanted a permanent solution. Is it worth getting a consultation for surgery based on what you see?

Nelson Lee Novick, MD · Answer

It was a bit difficult to determine from the cropped photos provided, however, there is a strong suggestion of volume deficit in the cheeks. And, since the upper cheeks are a major support to the under-eyes, revolumizing the cheeks using a robust HA volumizing filler can not only created a more feminine, oval, heart-shaped face and ogee curve, but can create a smother transition between the upper cheeks and the under-eyes and mask the under-eye bags. In experienced hands, this can be performed in about a ten minute treatment sessions with immediate, on-the-spot results. Surgery is expensive, involves post-operative downtime, and carries the risks of scarring. At your young age, you would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert and be sure to ask to see his/her personal before and after photos prior to agreeing to proceed. Best of luck.

Chet Mays, MD · Answer

Thank you for submitting your question! A lower bleph would be a great option as that procedure will remove excess fat and excess skin from under eyelids and it is a permanent solution. Filler wouldn't decrease the fullness as that would add more fullness to your under eyes. I recommend booking a consultation with a board certified plastic surgeon like myself to come up with a plan to best achieve your desired results.

Jason Emer, MD · Answer

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best, 
Dr. Emer

Andrew Miller, MD · Answer

Based on your photos, you are a great candidate for lower lid surgery. The excess fatty bag can be decreased in size. At the time, the area underneath it around the orbital bone has hallowed out and would look great with a little fat injection at the same time. That would give a nice, natural flat contour under your eye. Be sure to see a facial specialist for consultation.

Keshav Magge, MD · Answer

Hello, thank you for your question.  Based on your photos I think you would be an excellent candidate for a Transconjunctival blepharoplasty to remove the bulging fat and smooth the lower eyelids.  You may also benefit from a skin pinch procedure as well to remove any loose skin.  I often perform these under local anesthesia with sedation.  Best to speak to a board certified plastic surgeon.

Lexie Wang, MD · Answer

This is not a problem to treat with filler, and the fact that you notice worsening of swelling with salt intake/allergies suggests that filler would only make the problem worse, as filler will trap water into the area. You need to get a lower blepharoplasty. That is the only correct (and permanent) solution to what you are seeing.  Good luck

William Portuese, MD · Answer

The photographs demonstrate herniated fat bags in the lower lids, and you are a candidate for a trans conjunctival lower eyelid, blepharoplasty to remove those herniated fat bags in the lower lids. The incisions are located completely on the inside of the lower lids, and there's no external incision whatsoever.