Is a transconjunctival blepharoplasty right for my genetic under eye bags?
I'm only 28, but all my life I have hated my hereditary under eye bags - thanks Dad!
I think I am ready to take action, but I am extremely nervous.
One of the doctors I consulted with spoke against simply "repositioning" the fat because
"it doesn't tend to stay where you put it"... not sure of the truth of this.
My main concern is that he will not be conservative enough and too much fat will be removed, eventually
giving me a hollow look... either soon after the surgery or as I age.
Thank you for your question!
You’re 28 years, you’ve had puffy under eye bags that you give your dad credit for
and you’ve had a consultation with your doctor and you state that this dog phrased
to you that fat repositioning tends to stay where you want it to or essentially, the predictability
is a question mark.
Your question is whether or not to trust their opinion and your underlying fear is that you’ll
look too hollow.
And so now you presented this question to us
To give you a little bit of background about myself, I’m a board certified cosmetic surgeon,
certified by the American Board of Cosmetic Surgery.
My background is also in oculofacial plastic surgery, fellowship trained to the American
Society of Ophthalmic Plastic and Reconstructive Surgery also oculofacial plastic surgery.
My background training before cosmetic surgery was in eye surgery and then I’m a specialist
in cosmetic reconstructive surgery of the eyes.
I’ve been in practice in Manhattan and Long Island for over 20 years.
So to begin with, it’s clear that you understand that you do have under eye bags and that the
under eye bags are caused by fat prolapse.
Now this fat prolapse, the question is what to do about it.
And certainly, you have this opinion about transposition which you’re questioning.
Now to understand what you’re afraid of so-called hollowing, you have to understand
what the definition of hollowing is.
Many people fear that their eyes look hollow after eyelid surgery but very often, the concern
is really because the eyelids are retracted.
In other words, the eyelid being pulled downward, causes more of a hollow look overall than
the absence of fat under the eyes.
The other factor to understand is there is a relationship between the eyelid area or
the orbit or the space around the eyes and the cheek area.
And if someone has a very flat appearance, sometimes they may interpret that once the
bags are gone, they look hollow.
So when I look at a patient, I always look at these relationships and discuss with them
what they expect after surgery.
Very often, the tear trough area may be relatively hollow or the eyelid cheek junction can be
relatively hollow and the submalar area can be relatively hollow.
And all these go under the umbrella of hollowness.
Now to address the question about transposition, now this is something that your question,
you being 28 years old and you’re doing your research, and unfortunately, you’re
feeling that you can’t necessarily trust the doctor.
And that’s not a good thing.
You should feel comfortable with your doctor and I’m not sure why you would not trust
your doctor’s opinion.
Anyone who has trained in a surgery specialty which performs cosmetic surgery and has a
lot of experience with eyes, certainly draws from their experience to give you an opinion.
And when the doctor says that the transposition may not stay where you want it to, certainly
I would say that this doctor is correct.
For several years, the idea of moving fat from the orbit into a space below the orbit,
has come and gone in different ways.
And there is always going to be doctors disagree in what they do but there is also a lot of
difference of how they do what they do.
So my own experience with fat transposition is that it does have a place but it does have
a limited indication.
And as a specialist, I see a lot of patients who have procedures like this who come in
2 years later saying, I’m still puffy.
And a lot of times it’s because the transposed fat didn’t stay where it was intended, part
of it may have disappeared and the rest of it ended back to the eye socket.
And so when you think about hollowing, think about it this way.
My consultations, I tell my patients that the puffiness under the eyes is a hernia and
that fat moving forward creates that herniated look.
Now imagine what your eyes would look like if you didn’t have the fat there.
Now that gives you a different sense of visualization.
That means the eyelid would follow the natural shape of the eye and go along and follow the
shape of the rim.
Now if there is volume loss along the rim or below the rim, then that can be addressed
in a variety of ways.
So I think you should meet with other doctors to get more confident about which doctor you
feel comfortable with and understand that there are more than a few ways but just to
give you my suggestion, if based on your photos alone, I would perform a transconjunctival
which means from the inside of the eyelid lower eyelid blepharoplasty.
Very often, we combine this treatment with platelet-rich plasma (PRP).
Even though you are relatively young, it does help with skin quality and it does help with
some volume of improvement in the eyelid to cheek junction but that combination has been
very successful for us.
20 years of practice and doing this type of approach whether it’s resection, transposition
or any other variations, there is an art to doing this sculpting and it’s judgment.
So an artistic eye, a sense or proportion, how much to take, how much to leave behind,
these are also important factors.
So you should feel comfortable and confident.
There’s a certain intuitive perception that if you take the fat and move it somewhere,
that it will make it look better and is “natural” but there is a flaw in all of this logic and
it depends very much on the individual patient and other factors such as skin thickness,
skin quality and the risks and benefits.
You have to think of all these things and have this factors articulated clearly so you
can make an informed decision.
So I hope that was helpful, I wish you the best of luck and thank you for your question!