Thank you for your question.
You submitted a single photo and you’re asking if you would be a candidate for lower
eyelid blepharoplasty as an alternative to the use of fillers and you submitted a photo
of the close-up of your eyes.
Well, I can certainly give you my perspective of how I counsel patients like yourself who
come into our practice.
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 and certainly, this
type of question shows how the world continues to evolve in our field.
And not so long ago, a question is always asked, can fillers be an alternative to blepharoplasty?
So it’s understandable why you’re asking this question because certainly, a lot of
people would suggest to you to do fillers.
So I’ll give you an understanding of my thought process as well as how I counsel my
patients about the role of fillers versus surgery and in the whole context of your appearance.
So to begin with, we have to first start with anatomic definition.
Very quickly, people are eager to jump into solutions.
And very often, the solutions that are being offered are based on the bias of the practitioner.
So if you go to someone who just does skin, they may say, “Then do laser.”
And if you go to someone who only does injectables and non-surgical, they’ll say, “Well,
you need to just do injectables.”
And so I can understand why you get confused.
So let’s start first with the anatomic issue.
You have puffiness under your eye.
Now that in itself means that you have something called lower eyelid fat prolapse.
This means that fat that is normally around your eyes has pushed forward and is causing
a certain amount of puffiness.
Prior to fillers, transconjunctival blepharoplasty would be my recommendation and certainly,
it is a valid approach because it is a definitive approach.
And although your puffiness may not be that significant, in the grand scheme of things
and I think you’re already seeing that if you do a procedure like a lower lid blepharoplasty,
you’re essentially, for that particular element of your facial appearance, you’re
basically done.
You’re not going to need to keep going back and forth for fillers.
A lot of times, I have observed that people developed something called filler fatigue.
They go for injectables in an area that particularly is challenging.
The under eye area requires a lot of finesse to get a beautiful result with fillers and
dealing with some of the downsides of bruising and swelling can make someone think twice
about wanting to do it again.
So in a situation like yours, it would be typical for me to recommend lower eyelid blepharoplasty.
To help with the dark circles and the skin color and quality, I would use platelet-rich
plasma (PRP) and I might even consider laser depending on what I would see in a 3-dimensional
examination.
Now that being said, when I talk to my patients about lower eyelid blepharoplasty, they are
often concerned about the paradox of hollowness, the hollowness being prior to blepharoplasty
where they feel the valley next to the puffiness.
So I show them often that if you look from a side view and three quarters view that there’s
actually volume loss below the rim of the bone called the orbit.
And so there may be still a value to fillers but not exactly the same place.
There may be a value to place fillers at the eyelid-cheek junction or in the cheek area
to help blend but that’s more of an icing or further enhancement of the global area
and not specifically for the under eye puffiness.
So the art of doing lower eyelid blepharoplasty in a situation like yours is knowing how much
to sculpt and how to maximize the outcome or contour so that it looks natural and it
doesn’t look like you had surgery.
So just from the photo alone, I would suggest that you are probably a candidate for lower
eyelid blepharoplasty.
So I would recommend that you meet with a qualified, experienced cosmetic surgeon who
does a lot of eyelid surgery and learn about your options.
Like I said, from my perspective, you would be someone I would generally do a procedure
like transconjunctival blepharoplasty and platelet-rich plasma (PRP) derived from your
own blood to stimulate the skin quality, growth factors that generate collagen, blood supply
and possibly a type of fractionated laser.
So again, meet with a qualified doctor.
Maybe get a few opinions and go with a doctor you’re comfortable with.
So I hope that was helpful, I wish you the best of luck and thank you for your question.