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

The Patient's Question: I have fat pockets and saggy skin under my eyes. I have had Lasik surgery which caused dry eyes and I used Restasis. One doctor told me if I had the bags removed it might make my eyes even drier.

The patient before and after the suggested cosmetic surgery procedures. Photos courtesy of Dr. Robert M. Freund

Dr. Freund's Answer: In reviewing your photos, I can see a little hollowing of the area under your eyes. However, I do not see the significant fat pockets and sagging skin you speak of. Furthermore, I agree with your doctor that there are certain surgical procedures of the lower eyelid that can exacerbate your dry eye problems. To reduce the risk of any dryness, I would choose procedures that minimize these risks.

So, to improve the sunken area under your eyes, I suggest a little added volume to compensate for the loss of soft tissue. I prefer autologous fat transfer for this purpose. Fat is taken from your belly or hip, processed, and then reinjected into the hollowed out area to restore volume. Ideally, the fat survives as a graft for a long time (more than a year) as opposed to other fillers that disappear over a shorter period of time. The cost for fat transfer is about $2500. My favorite system is the Viafill system because it is a disposable (reduced risk of infection) system that provides smooth fat for a natural result without the problems of overfilling.

More importantly, I can see excess neck skin and neck (platysmal) bands that make you look older. The finding of an aging neck and hollowing of the under eye area is a common early finding of aging.

For the neck problems, I would advise a neck lift. My favorite technique is the Corset Platysmaplasty, first described by Dr. Joel Feldman. This technique is durable and the best of all techniques that I have used. In the photos, I have shown what you could expect with surgery. Note: the after photo was computer generated.

One of the best parts of a neck lift is the short recovery time (one to two weeks). Typically, the incision is placed under the chin (in the skin crease) and behind the ears. Cost for a neck lift is $5000 to $8000, depending on the region of the country you live.

In creating a unified treatment plan, I would advise a regimen to enhance your skin, autologous fat grafting to your lower eyelids and cheeks and a neck lift. To learn more about these procedures, get my book, "A More Beautiful You - Reverse Aging Through Skincare, Plastic Surgery and Lifestyle Solutions."

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.

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