Thank you for your question. You stated in your question you're 20 years old and you
feel very demotivated about your situation and you described your under eye area as having
puffiness, dark circles, blackheads. You've tried creams and you're looking for some guidance
and you've submitted two photos.
Well I believe I can give you some guidance. I'm a Board-certified cosmetic surgeon. I'm
also a Fellowship-trained oculofacial or oculoplastic surgeon practicing in Manhattan and Long Island
for over 20 years. My background training in oculoplastic surgery began with eye surgery
residency, followed by advanced training in cosmetic and reconstructive surgery of the
eyelids. Performing eyelid surgery is a very significant part of my cosmetic surgery practice.
So when I look at someone like yourself and with just photos alone, I always think about
what is the dominant feature. Certainly when you have a list of concerns it's important,
but at same time we want to create some type of a hierarchy so we can have a rational approach
to how to address these issues.
So for me when I look at your eyes, the first thing that I see is puffiness, and that's
usually the case for a lot of people because the puffiness still dominates. Now let's say
for argument’s sake, you wanted to do something to improve your under eye discoloration or
you wanted to do something to try to camouflage the puffiness. If the puffiness is the dominant
feature then those other treatments don't have the kind of impact unless you treat what
is dominating, so I think that we need to really focus in on that.
Now what causes puffiness under the eyes in a 20-year old man? Well essentially majority
of time in our practice we see patients who have similar issues—it’s genetic lower
eyelid fat prolapse. Now what that means is that there's a family history or a family
trait that gets passed along and the fat that's normally around the eyes actually prolapses
forward and creates these bulges of fat. This is one of the many reasons why the creams
that you tried did not succeed. There's no shortage of creams that claim to help under
eye puffiness, but the reality is when you have fat pockets, none of those creams can
work.
What we typically do for someone like yourself, and again this is without a physical examination,
you have an option if it's slight lower eyelid puffiness we can camouflage that puffiness
with the fillers such as Restylane or Juvederm. But typically, when someone has genetic puffiness
and it is significant, then the more definitive procedure is something called lower eyelid
transconjunctival blepharoplasty.
Now this means that what we're doing is we're addressing the fat pockets surgically from
behind the eyelid, from the inside. Now that might sound daunting but what we've done in
our practice is we perform our surgeries under local anaesthesia with light sedation in our
Joint Commission-approved facilities in both our offices. This takes away a lot of the
concerns that people have about the scary word “surgery”.
But when you think about it, the way we do this procedure is so minimally invasive. What
we're doing is going from inside the eyelid, making a small opening in getting to the fat
pockets and actually definitively treating the underlying issue which is the fat prolapse.
Many times patients come to us who had this similar type of situation but instead, they
have all of this filler placed around their eyes and it makes their eyes even look puffier,
and for them what we do is we use something called hyaluronidase which dissolves the hyaluronic
acid or the Restylane, Juvederm, whatever they've used, to help reveal what the real
issue is.
For your situation I would start with that. I would probably address the discolorations
with platelet-rich plasma which is derived from your own blood and it is used to help
stimulate collagen and improve blood supply. Although it is generally reserved for people
with more age-related issues, we found that very often, when we’re treating a younger
person with these discolorations, there is a successful synergy of reducing the puffiness
and improving skin quality to yield a better result.
I think it's important that you meet with qualified, experienced cosmetic surgeons and
learn about these options. I think you've reached a plateau as far as your self-treatment
and as difficult as it may be to at least have this discussion, I think going out and
meeting with doctors and learning from a three-dimensional examination what the situation is for you
and maybe try other things but usually when you have an issue it's better to treat the
issue rather than treat around the issue.
So I think that that would be the way I would go and I think that once you’re comfortable
with the doctor you'll find that having this treatment, your eyes will really look a lot
better. I would say that lower eyelid surgery or addressing puffy bags under the eyes is
like having a facelift—it really just brightens up the whole face.
So I hope that was helpful and I wish you the best of luck. Thank you for your question.