Can persistent under-eye concerns be addressed and if so, what would be recommended? (Photos)

Question

My under eyes have always bothered me and now that I’m a balding man, getting ready to shave my head, seeing what I’d look like bald, they really bother me (bald heads can look great on handsome faces). I’m ready to address my concerns but I’m not sure what the actual diagnosis would be and what would be the most appropriate action to take. I’m wondering whether this looks more like lower-eyelid fat pads, fluid retention/festoons/malar edema, tear trough hollowing, or something else. Sometimes the under eyes look hollow (outside of eye) and other times I can pinch extra skin (mostly in morning). When I smile it always makes my eyes look extra puffy. This area always looks worse in the morning when I first wake up but once I shower and use my moisturizer, everything usually bounces back into place. As I get older, I’m noticing that it takes longer to look more presentable. I really dislike the tear trough contrast and puffiness more than anything, although I really don’t like the cheek descent either. The first few pics in red shirt are me in my 30s. The next pics in green shirt are me in my 40s. The last few pics are me at age 53. As you can see I’ve had these concerns for a long time. I don’t want to look completely different, just subtly tighten things up to feel more comfortable with a bald head. Thoughts on what would work best for my concerns?

Young Min Im, MD, PHD · Answer

Based on your photos, the signs of aging appear to be more pronounced in the under-eye area than in other parts of your face. The tear trough hollowing has become deeper and more noticeable over time, and there is significant volume loss throughout the under-eye region.
As we age, the fat and soft tissues beneath the eyes gradually descend. This can create heaviness over the upper nasolabial area while simultaneously causing the under-eye area to appear hollow and sunken.
In cases like yours, a standard lower blepharoplasty alone may not be sufficient. I would recommend a SOOF Lift (Sub-Orbicularis Oculi Fat), also known as an Extended Lower Blepharoplasty. This procedure elevates the descended soft tissue vertically and repositions it to restore volume beneath the eyes. By addressing both tissue descent and volume deficiency, it can create a smoother transition from the lower eyelid to the cheek and provide a more youthful, refreshed appearance.
The procedure not only improves under-eye hollowness but also helps reduce the appearance of heaviness in the midface, resulting in a more rested, youthful, and naturally rejuvenated look.
One important thing to understand is that our goal is to improve your current appearance, not to completely erase every sign of aging.
Once wrinkles have formed and become established, it is not possible to remove them 100% completely, even with surgery. Instead, the goal is to soften their appearance, reduce their depth, and make them less noticeable.
Our ultimate objective is to create a more refreshed and youthful look while maintaining natural-looking results, rather than making the wrinkles disappear entirely.

Can persistent under-eye concerns be addressed and if so, what would be recommended? (Photos)

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