Thank you for your question.
You submitted your question with a photo.
And you’re asking are you a good candidate for transconjunctival blepharoplasty with
fat repositioning.
And in the details of your question, you state that you’re 25-years-old and that you are
bothered by the hollows under your eyes and you’re looking for some guidance.
Well, I can certainly share with you how I discuss options with my patients every day
who come with very similar concerns.
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 under eye area whether it’s for under eye bags, bags with hollows,
hollows alone, discolorations, wrinkles, essentially, the aesthetics of the eye area has been the
foundation of my practice throughout my career and has continued to evolve thanks to a lot
more tools that we have and customizing a strategy.
So I can certainly understand your concerns about hollows and the attraction of a surgical
procedure where you can reduce what is the fat pocket that is present and to try to fill
the hollow which is your primary area of concern.
Now of course, a proper physical examination would involve taking pictures and examining
the three dimensional aspect of the level of the prolapse of the fat and the relative
impact on the under eye tear trough area.
I would say that fat repositioning, although it is a reasonable concept when it comes to
trying to move fat from one area into a trough area, I would be cautious about using that
as a first-line of therapy.
I can tell you that the goal for most people who have any type of aesthetic issue is to
have a procedure that is predictable, that is safe, that is not likely to have any kind
of untoward complexities beyond the procedure.
I think the tolerance for variability and outcome is becoming essentially almost zero.
But beyond that, I would say that the tools that we have in front of us that we use routinely
also change the hierarchy in which recommendations are made.
So in a situation like yours, I would probably not do a surgery, again, based on just a photo
alone, for a limited amount of fat prolapse where the hollow is the more dominant issue
for you.
I would, in your situation, consider a, first for the hollow area, I would use an injectable
filler such as Restylane and I would place that in the tear trough area.
That would help with the transition between the fat pocket and the area where it’s hollow.
And further, discoloration which is also an important variable in the perception of under
eye dark circles and hollows, I have found a lot of value in using something called platelet-rich
plasma (PRP).
Now of course, when someone is relatively young, a 25-year-old, I would make that decision
based on examination looking at skin quality.
But at the same time, there has been value in using platelet-rich plasma (PRP) for discoloration
if it’s from environmental causes as well as just as a general skin improvement concept.
Basically, your platelets are concentrated in plasma after the blood is spun.
And the growth factors and healing factors help stimulate collagen, stimulate vascularity
and improves the skin quality.
Now when we deal with someone who is relatively young, it still seems to have a value when
done in conjunction but it is evaluated in an individual basis.
A lot of times, I take little steps and I start with just a filler and see how much
an improvement we can achieve.
It’s always important to always manage the cost of doing things with the outcome.
And I generally lean towards using PRP for people who have history with sun exposure
that is significantly aging the skin as well as other issues that would require an improvement
or there would be a more significant benefit to skin quality.
But when it comes to the anatomy of the under eye area, essentially if the fat prolapse
is minimal, then I would suggest considering filler as a first-line therapy.
Now you may not be excited about doing this as a maintenance type of basis but generally
speaking, a filler under the eye can last up to a year and it is not unusual for it
to last longer.
I think that in a way, both the predictability and the convenience and the relative expense
makes it an attractive first-line option.
I think that without going into unnecessary details, that would not be my first-line.
I would be concerned that any type of surgery where you’re taking fat and trying to move
it in an area can be problematic in terms of swelling, lumpiness, irregularities.
And so, I think that’s a variable that you should be aware of before just doing something
that may be attractive because you may perceive it has having a long-term benefit in comparison
to a filler.
So I think it’s very important that you meet with qualified, experienced surgeons
who perform both injectable filler and surgery such as lower eyelid blepharoplasty and learn
what options makes sense to you.
As an oculoplastic surgeon who has no real limitations and has extensive experience,
I would say that it has been tremendous to have the tools and the techniques to do things
for patients like yourself with less invasive approaches than surgery because ultimately,
our goal is to help our patients look their best in the safest and most predictable way
possible.
And it’s always a balance of relative risk.
So I hope that was helpful, I wish you the best of luck and thank you for your question.