Thank you for your question.
You submitted a single photo and you state in your question that you are in your late
30s and that you’ve had an issue with struggling with under eye bags and dark circles and that
at a certain point, you’ve had Ultherapy performed for this concern of yours and you
feel like that it didn’t work out very well at all and so you are asking will fillers
help you with this problem without you going under the knife as you stated.
Well, I can certainly help you with how I approach patients with similar issues in my
practice which I deal with pretty much every day.
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 helping people
with their under eye bags and the challenges with this issue is something we do every day
all day long in my practice.
So, I can certainly understand your frustration and we see this all the time.
I think that in many ways, the many advances of the instruments and methods we have to
help people look their best has come with a lot of confusion and a fair amount of frustration
similar to the experience you had.
I think it is important to really first understand the anatomy.
It always comes back to basically understanding anatomy.
The anatomy of your problem right now of the under eye bags is something called lower eyelid
fat prolapse.
Lower eyelid fat prolapse means that fat that is normally around your eyes pushes forward
and creates this bulge often referred to as herniated fat.
Now it is something that, thanks to newer methods, whether it is a thermal energy device
or injectables, there are ways to basically camouflage this area.
But when you think about the anatomy, the fat is significant enough in volume that it’s
pushed forward so it is understandable why thermal energy device did not accomplish what
you wanted because it is very difficult for the skin to really tighten adequately enough.
Now with thermal energy devices, you can reduce fat but it generally doesn’t work that well
when it comes to the under eye area and it is basically a limitation and the frustration
with thermal energy devices to deliver whether implied or intentionally stated the same results
as surgery, invariably results in this level of frustration and it is not specifically
to the device that was yours but I think a lot of people are just so afraid of surgery,
they try to do so many different things and end up spending a lot of money and wasting
a lot of time.
So the question is whether or not fillers will help you avoid going under the knife.
Well, let’s put it this way.
If a certain amount of puffiness is below a certain threshold then anatomically, a filler
may camouflage that area and what does that mean?
If you look at the bulge of fat, think of it as a mountain.
And when you look at the hollow next to it, the tear trough area, the under eye area,
the rim of the bone structure, well that area potentially can be filled up to a point with
a hyaluronic acid fillers such as Restylane.
Now, it won’t definitively treat the underlying problem but it might camouflage enough for
you to feel comfortable.
Now, to help people like yourself put things in perspective with the under the knife fear,
I explain to my patients that essentially, anytime you enter the skin, it is an invasive
procedure and I do a lot of fillers for under eye bags so it’s not like I’m against
it but I have to do it selectively.
So when you enter the skin, you can potentially have swelling, bruising and irregularities
so it is not exactly a perfect solution but it can be a way to help buy you some time.
In our practice, when we deal with people who have puffiness like yours who are ready
to do a more definitive procedure, I typically will do something called transconjunctival
blepharoplasty.
This is something that we do in our practice under local anesthesia.
This way, patients are not afraid of going under general which is the greatest objections
to have a surgery.
It is done on the inside of the eyelid.
It is basically no external incision or scar and it is done with a little bit of sedation
so people are relaxed and it is done within an office setting.
So this way, the fear of going to a hospital or a surgery center is eliminated altogether.
So in a way, I’ve been very successful in trying to make this process whether it is
an injectable or a surgical procedure as close as we can make them and still adhere to very
high standards of safety and process.
We are certified by the Joint Commission, the same entity that certifies hospitals and
surgery centers.
So I think that it is very important for you to find a doctor who can give you honest guidance.
I think that’s one of the frustrations.
When people bounce around and they respond to different enticements, they will often
be frustrated because the people offering these different enticements are really looking
for a transaction rather than a long-term relationship and I think that’s very important.
And so find a doctor that you feel you can work with for not just the procedure but for
the years to come.
I always say that besides being a surgeon and doing all these procedures, I’m like
a primary care doctor for beauty and I think that’s a very good relationship to have
and that way your doctor who you feel comfortable with will guide you through these interesting
waters as new ideas, technologies, injectables, lasers and other things keep popping up and
everybody keeps running like a herd in these directions.
So I hope that was helpful, I wish you the best of luck and thank you for your question.