Unbelievable bags under my eyes. Lower Bleph or Facelift or..?
When younger, I always had deep hollows & the purple veins also showed through my thin skin.
Bags started around age 40. They swell some days more than others, but are ever-present.
Had an upper bleph 3 years ago and love the results, but lower bleph scares me. Also have
I do it just right! Would a facelift be the way to go, or just a lower bleph, or a combo?
What approach would you recommend? Seems tricky.
Thank you for your question!
You submitted a question where you described your eyebags as being unbelievable and you
are hesitant about pursuing lower eyelid surgery and you are somewhat confused about the decision
on whether to do a facelift or lower lid blepharoplasty and the decision is a little tricky based
on your own observation that when you physically lift your face that there's improvement.
So, as a cosmetic oculofacial surgeon specializing in facial aging surgery for 20 years, I do
a lot of lower eyelid and upper eyelid surgery as well as face and neck lifts so I can share
with you my experience doing this for 20 years. First let's understand that the lower eyelids
and the upper eyelids are in a very unique space which we call the orbit. And although
when you physically move everything, we call that the mirror lift, it may look better but
it is not in a level that is truly sustainable when you do aggressive face lifting.
So, the short answer to your question is, the lower eyelid procedure and the face lifting
procedure are two separate procedures. Although there may be some secondary benefit to the
lower eyelid by repositioning the cheek as occurs in a facelift. Trying to change the
lower eyelid position, tone and overall appearance from a face lifting procedure is not likely
to proceed.
The lower eyelid is a very complex structure and I think that your hesitation is well founded.
Again, as a specialist, I deal with patients from all over the world, many from the United
States where they had lower eyelid surgery by board certified plastic surgeons and they
have had severe lower eyelid retraction, skin loss, exposure, their lower eyelid is disconnected
from their outer corners, all kinds of things. Lower eyelid anatomy is fairly complex and
it is deceptive when people have an understanding, when I say people, I mean surgeons, who have
an understanding but don't do this as a speciality will sometimes get themselves in trouble because
of the limitations of what they know. So, the lower eyelid tone and position is so critical
that you really should make this an important point in your decision making process when
you meet with prospective doctors in choosing who to do your lower eyelid surgery.
Separately from that, for the lower face, jowl area, a procedure such as a facelift
and face and neck lift is typically what we do. And very often, we will combine the lower
eyelid surgery with the face and neck lift surgery. So, that being said, when you meet
with a doctor, the way to help you understand if the doctor understands truly has a mastery
level of the lower eyelid surgery, various tests are done to check the tone of the lower
eyelid such as pull test or a snap test. And with that, there are options on how to ensure
that the lower eyelid position is maintained or enhanced in some cases where it sags significantly
doing procedures such as lateral tarsal strip. So when you are doing your consultations,
you may decide whether to do them together, the procedures together that is, or to do
them separately if you are that concerned. And it might be practical for you with that
level of anxiety to do the lower eyelids first and make sure everything turns out right.
In our practice, we don't use general anesthesia routinely for any procedure. So we do everything
in local LITE sedation. By doing that, our patients have the benefit of being able to
make their decisions based on their own comfort rather than the decisions where there's an
incentive to do as much as you can because you are going under general anesthesia.
That being said, learn more about the situation you have with the lower eyelids. When you
said they are really unbelievable, it might reflect the fact that there's a lot of sagging
and loss of structure and quality of the position and function of the lower eyelid so there
may be a lot more needed in order to get a nice result and so your anxiety is probably
well founded. So that being said, meet with qualified experienced cosmetic surgeons about
your lower eyelids and the face and neck lift and once you feel comfortable, move forward
and have these procedures done. I wish you the best of luck, I hope that was helpful
and thank you for your question!