In our weekly Post Your Face column, Dr. Robert Freund answers readers' cosmetic surgery questions, and shows them how they'd look if they underwent the enhancement. To post your own face, visit postyourface.com.

The Patient's Question: The bags under my eyes make me look and feel older than I am. My jowls are starting to hang and my forehead is full of permanent creases that make me look like I am scowling. My chin is starting to sag too.

The patient before (left) and after (right) the hypothetical procedures. Courtesy Photo




Dr. Freund's Answer: Thank you for submitting your photos. You have beautiful eyes and a lovely oval shaped face. I can see the early signs of jowls from your pictures, but most striking is the hollow look below your eyes. This is most likely the result of sagging or loss of the cheek tissue that comes with age, some bulging of the fat around your eye, or a combination of the two.

If you only have sagging or loss of the cheek tissue, a procedure called autologous fat transfer would do wonders for you. This involves taking some of fat from another area of your body, processing it, and then reinjecting it into the area under your eyes. The technique I favor is the disposable Viafill system (full disclosure, I invented this). The cost for this is $2,500 and downtime is less than one day.

If your hollow look is the result of bulging fat from around your eyeball then I'd advise a Lower Eyelid Blepharoplasty. This is a surgical technique that removes the excess fat and bulges and fills in the hollows with fat. The procedure requires anesthesia, will have a 7-10 day downtime and will cost about $4,000.

On to your other concerns...your jowls and neck issues are extremely minor, which leads me to wonder: Is this the best time for you to have cosmetic surgery? I am often asked if surgery should be done early or late. I personally feel that no surgery should be taken lightly and should be done at a time when correcting the problem won't create a change that screams "plastic surgery excess!" Conversely, we always want to hold off procedures until the results are transformative and will make the patient happy.

I always want my patients to look natural, to appear that they lost a little weight or are well rested from a vacation. So I'd advise you to hold off on the neck or jowl surgery for the time being, and instead focus on the areas under your eyes. You won't be disappointed.

Respectfully submitted,
Robert M. Freund, MD, FACS

The health or medical information in this article is for informational purposes only and is not intended to be used as a substitute for professional medical advice, diagnosis or treatment. Please consult your doctor or a qualified healthcare provider with any questions.