This is a question that I answered for someone who had a procedure by another physician.

Asymmetry can occur very commonly after upper and lower null or eyelifts. I may see that the left eye is slightly larger in the bottom part of it where the white is showing. This is sometimes due to the skin being taken which can cause contraction of the skin downwards making the eye larger appearing. The bags can be due to a number of things. When it is located right under the eyelid margin it is likely coming from the fat within your orbit of the eye. This fat can be easily removed. When it is lower it is likely due to the eye muscle that surrounds your eye socket and that helps you close your eyes that is causing the bag. This is called the malar crest and it usually is due to the eye muscle hanging over the smiling muscles.

Midface lifts can improve these malar crests but volumizing this whole area can improve the appearance of this cheek region. The larger appearing left eye can also be due to ptosis of the right eye or swelling. Ptosis is when the eyelid margin becomes droopy in relation to the iris. Ptosis can be temporary and can last months if caused by the procedure. Other times, the ptosis can be due to an actual injury to the muscle that opens up the eye (the muscle that pulls up the eyelid margin). This can require a more formal repair and is very difficult.

Dr Young’s office is in Bellevue near Seattle, Washington.

Botox can prevent the muscles under the null from bunching and can reduce the wrinkles for a while. You can also get a laser peel there and will tighten up the skin in the area. A skin pinch can reduce the skin in this area also.

At age 19, a loss of volume from aging would be a little early for you. If this was the case, and you can find this out by looking at your pictures when you were younger to see if volume has decreased, you can add volume to the lower eyelid region with fillers and fat transfer. Given that you are so young most will likely suggest botox, skin care, sun protection. It would be better if you would send in pictures of yourself without smiling and you can tell how much volume you’ve lost in the lower eyelid area.

All of these procedures can be done in our office by Dr Philip Young MD in his Bellevue office near Seattle, Washington.

You can remove the bags under your eyes through a null through incisions under or inside your eyes. Skin can also be removed. This is the traditional method of doing this and improving the lower eyelid area.

You can also fill in the volume deficiency with fillers or some other volume enhancing method. Your lower eyelid has the baggy appearance often from the volume loss that occurs in the cheek area where the loss reveals the infraorbital rim. Replacing this volume can really enhance the appearance in this area with fillers. Fat injections may be the most natural way to improve this area and for a longer lasting effect.

These procedures can be done by Dr Philip Young MD at his Bellevue office near Seattle, Washington.

I refined a volumizing technique called the YoungVitalizer that entails replacing the volume in the lower eyelid and upper cheek area to reduce the appearance of lower eyelid dark circles and bags. This creates a more natural and younger look without looking like you had something done.  The YoungVitalizer is an amazing procedure that uses a persons own tissues to volumize the face for a more younger and natural look.

People age like a how a grape turns into a raisin. Surgeons are used to making the raisin smaller but a person doesn’t look anything like how the person looked like when they were a grape at a younger age. This principle of making a smaller raisin is done when surgeons employ the lower eyelid blepharoplasty. Although volumization with the YoungVitalizer can markedly improve the lower eyelid dark circles and bags there are times when removing fat can help the bags but it is less needed when volumization is done first. Volumization through the YoungVitalizer can create a more volumized cheek to match and be more level with the lower eyelid fat and bags.  The results are more natural.

The dark circles under your eyes can be due to the thin nature of your skin. This allows the muscle that is dark colored to shine through the skin and look dark when you look at your lower eyelid. The key in this situation is to add a layer between your skin and the muscle below. Laser resurfacing can add a layer to camouflage the muscle better.  Also adding a filler in this area can help as well.

Fillers such as restylane, Juvederm, or fat injections are possibilities. The other reason for dark circles can be due to the volume loss under the eyes which allows the fat within your eye orbit region to relatively protrude more to cast a shadow underneath the eye. Filling in this volume with fat can help that as well. Sometimes, taking out fat in the eye orbit can help this condition too. There are many things can be done to help this situation.