Looking at the picture, there are a few issues in the lower eyelids that need to be addressed in order to completely rejuvenate the lower eyelid:
- the bulging eyebag
- the deep tear troughs and lid-cheek junction lines
- mid face flattening
- and skin excess.
The extent of correction desired would impact on a few things:
- recovery time,
- scarless vs non-scarless approach and
- the "permanence" of the procedure.
It is important before choosing any corrective procedure to realise that the lower eyelids and hence the eyebags are dynamic structures and hence, doing something to correct the abnormality, such as a camouflaging procedure, may result in it looking good at rest or in a photo, but may not look as good when one is smiling or talking.
In my mind, surgical correction is the gold standard in treatment of moderate to severe eyebags with all the other issues illustrated in the photo in order to achieve a good dynamic result. Not only is the eyebag removed, but volume is added to the flat mid-cheek via a fat graft and excess skin removed and the mid face lifted via a mid-cheek lift procedure.
This also addresses the tear troughs and lid cheek junction lines. This produces a long-lasting result and without fear of eyebag recurrence; what recurs many years later is skin laxity and flattening of the mid cheek which gives the appearance of but is not an eyebag.
The difference, thus, with non-surgical treatment is how long the treatment will last and the extent of correction. Although there is a longer recovery time, what one obtains in exchange is a far longer period of rejuvenation.
