Thank
you for your question.
You submitted your question with a single photo. And you’re asking the best way to
help deal with a sunken under eye area. And you describe further in your question that
you are in your early 40s. A doctor stated to you that this is genetics. And further,
you understand that there is also puffiness under your eyes and you’ve tried all kinds
of creams. And at the same time, it seems you are very afraid of surgery because of
the possibility of a swollen bumpy appearance after surgery.
Well, I can certainly share with you how I provide guidance to my patients who share
very similar concerns as yourself. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years. Helping people with their
eyes to look better whether it’s upper eyelid sagging skin, drooping upper eyelids as well
as bags under the eyes is an overwhelmingly popular focus of my practice for my entire
career. And certainly, your concerns about safety and having complications does have
a basis.
The reality is that the eye area can be deceptively complicated. And a lot of times, patients
come to me from all over the world with issues related to procedures they’ve had with the
eyelids.
Now I think that it is fairly straightforward in my opinion when I look at your photo that
what you are dealing with and when you describe the sunken area is that you are dealing with
the contrast. The contrast is that the puffiness under your eyes creates essentially a mountain
and that the sunken area is the valley which makes it look even deeper. So you can actually
look at the sunken area and see it as very hollow but in reality, I think that my approach
would be to do something about the puffiness.
So how do we solve a situation where there’s lower eyelid fat prolapse and minimize the
relative risk. Well, I think one of the most important things to understand is that in
every area of medicine, specialization has tremendous value. And even within the broad
field of cosmetic surgery, it is well appreciated by most people I would say at this time in
research and being able to evaluate a doctor’s particular focus helps guide patients to make
these type of choices. So for example someone who chooses a doctor like myself knows about
my background of first training in ophthalmology or eye surgery and then doing plastic surgery
of the eye and the eye socket and the skin and the cosmetic area and then having a practice
focus, it means that I do this a lot.
So, essentially, my approach to your situation that I would typically do again in the absence
of a physical examination would be a procedure called a transconjunctival blepharoplasty.
What this procedure entails is approaching the fat pockets from behind the eyelids and
this way avoiding any incision on the outside and further avoiding any kind of compromise
in the eyelid muscles that are important in maintaining the structure. Basically, by addressing
the fat pockets from the inside of the eyelid, I am able to retain the natural shape of the
eye. It’s done very efficiently. You can almost describe it as minimally invasive approach
and the procedure is highly successful. I think this meets a lot of the concern that
someone like yourself has. And of course, people are always afraid of doing something
around their eye so I think a lot of our patients like the idea of having somebody who is also
trained in eye surgery work around their eyes.
Now that being said, it’s very important for you to have an understanding of what to
expect. And when I talk to my patients, I show them before and afters. I show them what
the typical appearance is for a wide variety of patients. And generally speaking, I think
it’s very clear that the message is that maintaining the shape and character of the
eyes is critical.
And further, what you describe as small and bumpy is very often the consequence of issues
related to different strategies which can be compromising the lower eyelid. The lower
eyelid is actually deceptively complex. It’s a balance of many important anatomic structures,
everything from the tendon that holds up the eye, the muscles that support the eyelid.
There’s a lot of definitely subtle balancing forces that can have tremendous impact on
the shape of the eye.
So it is understandable your concern but at the same time, your concerns can be addressed
so that you can get a successful outcome with minimal risk. When we talk to our patients
about these risks, we already covered qualifications and experience, a lot of times, people are
also afraid of general anesthesia. Well, we do all of our procedures under local anesthesia
with LITE™ sedation. So this way, people who are afraid of being awake throughout their
surgery can be comforted by the idea of getting a little bit of sedation but at the same time,
not having general anesthesia. The procedures are done in our office, in a facility that
is certified by the Joint Commission which is the same certifying organization that covers
hospitals.
So essentially, the combination of the safety, experience and the convenience of having these
procedures has made it easy for patients to have these procedures in our office every
day. So I think that if you are ready for something that is more definitive, meet with
qualified, experienced cosmetic surgeons. And if you want to even further have a doctor
who has an eye surgery background, I think that will only be helpful for you to feel
more comfortable. Now of course, no doctor or no procedure is without risk of complications
but at the same time, when you do anything in life, you are dealing with probabilities.
There’s crossing the street and driving a car. You try to maximize the probability
of a safe and predictable outcome. So I think you’re moving in the right direction at
this point.
So I hope that was helpful, I wish you the best of luck and thank you for your question.