Thank you for your question.
You’re 20-years-old and you submitted a single photo and you state in your question
that you’ve had under eye bags since you were 7.
However, you felt that earlier, your under eye bags were related to allergies and as
your issues with allergies improved, the under eye bags remained.
You are looking for a solution other than invasive surgery.
You feel like the under eye bags make you look tired and old.
Well, certainly I can give you my perspective on how I approach patients like yourself in
my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years and under eye bags
is one of the most common issues we address in our practice.
So to begin with, it is very important for you to understand the relationship between
allergies and other factors which contribute to the presence of under eye bags.
Yes, allergies can make under eye bags look worse but when you think about it, understanding
that bags that are always there regardless of the presence of allergies means that there
is something more anatomic that’s constant.
And what is that?
Well, what that is, is called lower eyelid fat prolapse.
Lower eyelid fat prolapse means that the fat that is normally around your eyes pushes forward
and creates a bulge, a bulge under the eyes that makes the eyes look tired.
Now, we live in a time where we do have more than a few ways to address the cosmetic appearance
of the under eye bags and so it is clear that you are concerned about undergoing surgery
but I can share with you basically the way I discuss the options with my patients in
my practice.
For someone who has a small degree of puffiness where it’s kind of a little, just mild and
present enough that they notice it but not significant enough that it is really pushed
forward, we can offer the option of a non-invasive approach where a filler is placed under the
eye bag in the hollow area.
This area is commonly referred to as tear trough and the way that’s done is still
a procedure.
So you stated that you are concerned of invasive surgery.
I would say to you that really even placement with a filler is invasive.
Anytime you go through the skin, you are technically invading the space.
So whether it is through a surgery or with an injectable, understand these are invasive
procedures.
They are different degrees of invasiveness but it is still invasive.
Going back to the strategy, what we do is we place filler using special instruments
referred to as blunt cannulas into the tear trough area and add volume so that the hollow
becomes less obvious.
When you place a filler in this area, you are essentially softening that appearance
and that filler can last from anywhere from 6 months to several years.
Very often, we also try to improve the skin quality.
To improve the skin quality, we use something called platelet-rich plasma (PRP).
Platelet-rich plasma (PRP) improves the quality of that very thin skin under the eyelids which
can be affected by typically environment or eye rubbing and allergies and other issues
which can make the skin look more older than the rest of the skin on your face so platelet-rich
plasma (PRP) is also an option.
Last is a surgical procedure but I would submit to you that it is less invasive than you may
have an understanding of at this point.
The approach is called transconjunctival blepharoplasty.
What I am doing when I’m doing this procedure is addressing the fat pockets from the inside
of the eyelid.
Once I address the fat pockets, I’m reducing, sculpting, repositioning as is appropriate
to get the most optimal result so that the fat that has prolapsed, no longer is pushing
forward.
Now the appeal to this approach is that it’s a long-term solution.
For someone who is younger who doesn’t have other elements of facial aging, doing a transconjunctival
blepharoplasty sometimes combined with platelet-rich plasma as described earlier, is a definitive
procedure and you don’t have to repeat it.
When you have or I should say you don’t have to repeat it for how many years particularly
when you are doing this as young and we often say that eyelid surgery can last anywhere
from 5 –10 years but a younger person, I would say, goes even well beyond that.
When we talk about fillers and other maintenance procedures, there is some ongoing placement
and replacement as the material breaks down.
So there are pluses and minuses to different options and it is important you get a proper
understanding and perspective.
This means having a proper examination and having a meeting with a doctor who can offer
you all options, not just one or the other.
So, my recommendation is to meet with qualified, experienced cosmetic surgeons.
Learn about the options that I described about lower eyelid transconjunctival blepharoplasty,
the use of platelet-rich plasma (PRP) for skin quality and the use of hyaluronic acid
fillers such as Restylane for volume correction to try to soften the appearance of the under
eye bags.
Once you figure out what works best for you, you can move forward.
So I hope that was helpful, I wish you the best of luck and thank you for your question.