Thank you for your question.
You are 20-years-old. You submitted several good photos and you state in your question
that 2 years prior you underwent Asian eyelid surgery and that you’ve been aware of puffiness
under your eyes subsequent to that procedure and you want to know essentially is the puffiness
related to hormones, is it related to the original surgery that you underwent and what
is the solution. Well, I can certainly share with you my approach
to this type of question when it comes to our 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.
I specialize amongst several things in Asian eyelid surgery and I’m quite familiar with
the type of surgery you probably underwent 2 years ago and I deal with under eye bags
all day long in our practice.
So, I will certainly give you just basically the simplest, straightforward understanding
and what you are dealing with these under eye bags especially as you describe when you
smile and wink is bulges of fat and this is often referred to technically as herniated
fat. It’s fat that is normally around the eyes that pushes forward and creates these
bulges. Now as far as the cause is generally something that I see as a genetic trait that
is often seen in families. It’s not likely in any way to be the result of upper eyelid
surgery anatomically speaking it simply doesn’t make sense. If you are working on the upper
eyelid there is no trauma or any type of procedure on the lower eyelid that could’ve caused
some change anatomically in the lower eyelid so at least you cannot worry that the upper
eyelid surgery has something to do with this.
Now, whether hormones or other factors play a role in the expression of fat that’s a
question that is not likely to be an issue in your cause unless you have any issues related
to thyroid disease. There is something you call thyroid related immune orbitopathy or
Graves’ disease but it is not likely to be the case in your situation based on the
appearance in the photos. If you have concern about hormone levels and
this type of situation maybe with the thyroid since no other history is indicated meet with
a doctor and ask about this because it is important that you do diagnose any type of
hormonal issue before moving forward with the solution related to the under eye bags.
Now, as far as related under eye bags is concerned basically you have 2 options and I would probably
lean towards a more definitive option but I can explain to you how I make that decision.
When someone has mild under eye bags what we do is we can actually blend the appearance
of the under eye bags with the adjacent area called the tear trough. We do that with injectable
filler. We use a material called hyaluronic acid or in a trade name Juvederm or Restylane
to fill that tear trough area. In some situations we also use platelet-rich plasma (PRP) to
help the skin quality and further improve the shadow if there is any issue with dark
skin or I should say skin that has look like dark circles and that darkening makes the
under eye makes it even look more undesirable.
So, in those situations you have injectables as an option. Injectables do need to be repeated
so that’s part of the choice. Just in the first impression with your photos I would
most likely recommend something called transconjunctival blepharoplasty. Similar in a way to the upper
eyelid surgery that you had in the past with the exception that it doesn’t involve any
incision. This is a procedure where what we do is from the inside of the eyelid under
local anesthesia with LITE™ sedation and no general anesthesia and what we are doing
is essentially selectively sculpting, reducing, repositioning the fat that is under the eyes
that is pushed forward so that the pockets are diminished and the under eye bags look
better.
The appeal particularly in this approach is that it is a definitive procedure. Once it
is done you don’t have to do anything necessary to maintain unless you need something but
you’re 20 years old so I don’t think that is necessary the issue unless you have a lot
of sun exposure or you smoke or you have other issues related to the skin. That’s a different
topic all together.
Essentially, you are dealing with this prolapse you may want to meet with a doctor and now
discuss this question as to how to more definitively treat this area but understanding it wasn’t
necessarily related to surgery and if there is a question about hormones and other issues
meet with the doctor and have that checked out.
So I hope that was helpful, I wish you the best of luck and thank you for your question.