Q: Dr. Eppley, I am interested in blepharoplasty surgery. My upper eyelids are very heavy and my lower eyelids have large bags under them. They make me look very tired and old. Attached are some eye pictures for your review and recommendations.

A: Thank you sending your pictures. Both your upper and lower eyelids show considerable tissue redundancies. The upper eyelids have a lot of extra skin and hooding (skin pushing down on the lashes) and the lower eyelids show tremendous herniation of the orbital fat pads. They are so pronounced that you can actually see all three fat pads under eye distinctly. (medial, central and lateral fat pads)  You would benefit tremendously by both upper and lower blepharoplasties. What is unique about your lower eyelids is that your infraorbital bones are deficient so when the fat is taken away the bags will be gone but the eyes will look very shallow. For this reason that fat that would be removed actually needs to be repositioned so it is draped over the infraorbital bones to correct the tear troughs and infraorbital rim deficiency. So your lower eyelids fat pockets don’t need to be removed per se but they needs to be repositioned to get rid of the prominence and simultaneously correct the bone deficiencies.

Dr. Barry Eppley

Indianapolis, Indiana