Question: My skin is very thin and transparent in that area and the circle/hollow is sometimes worse on one side and some days look alright (rare)...hoping for something more permanent then filler. Would blepharoplasty sag over time like under eye bags? Would it benefit me to surgically tighten the under eye area if that is possible?
Dr A’s Answer: You have a classic negative vector lower eyelid. This means the bone is not forward enough to give you the nice outward curve of the upper cheek area and that the fat that in the eye socket then hangs out over the edge and gives you bags. The solution is as you suspect, not to remove the fat, but rather to support and fill the area under the fat. In my hands, I would suggest a tear-trough implant which directly fills that area and gives you the "bony" support needed. This is a permanent way to correct the problem which is stable over time and at any body weight. It is also reversible if for any reason you should choose to do so. I would also caution you against removal of skin in the lower eyelid.