Thank you for your question.
You submitted a photo and you state that you’re 40-years-old and that you have been dealing
with under eye bags and periods of swelling that you feel are related to water retention.
You underwent allergy testing and it came out negative and you’re looking for possibly
a surgical solution and you have the typical questions that most people have when they
are frustrated with under eye bags. So I’m going to offer you some ideas of how I approach
situations like yours in my practice.
A little bit of background, 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. Under eye bags and eye rejuvenation is one of the most common procedures
in our practice with a wide range of solutions and certainly, your situation is extremely
common.
First, I’m going to give you some idea of understanding the situation of the bags under
your eyes as it appears in your photos. The puffiness under your eyes that you feel that
always makes you look tired represents something called lower eyelid fat prolapse. Lower eyelid
fat prolapse means that the fat that’s normally around your eyes pushes forward and actually
creates a bulge and that bulge is subject to variability to water or fluid in this area.
So, allergies, sinus problems, salt intake, depending on individual hormonal situations
have some degree of affecting the expression of the level of puffiness. However, the underlying
most significant anatomic issue is fat pockets and this is why, commonly, people first try
over-the-counter creams and miracle solutions that don’t work because frankly, these fat
pockets are much too large to be dealt with under eye creams.
So there are basically two options when someone has under eye bags these days. If it’s slight
under eye bags, then we can actually soften their appearance by creating volume in the
valley of the area known as the tear trough using a filler such as Restylane or Juvederm.
In your situation, just in the photos alone, I suspect that you might not benefit as much
with that less definitive procedure which is putting the filler.
The more definitive procedure which I would typically do for someone like yourself is
something called a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is a surgical
procedure where the fat pockets are addressed from the inside of the eyelid. What we do
is we reduce them as well as reposition them and reshape them. And the point of doing that
is to address the contour so that the under eye area has a natural continuity and you
don’t have the bags under your eyes. Now, this is a highly successful procedure and
works very well.
In addition, we commonly combine this procedure to help the skin quality with something like
platelet-rich plasma (PRP) as well as laser. Platelet-rich plasma (PRP) is a concentration
of the growth factors and the wound healing factors from your own blood that stimulates
your collagen. People have been becoming more and more aware of this PRP or platelet-rich
plasma and it does a nice job of helping skin quality at the same time of doing this procedure.
Now this procedure in our office is typically done under local anesthesia with LITE™ sedation.
This means that you avoid general anesthesia, you avoid having to go to a hospital surgery
center. In our office, we have these facilities that are certified by the Joint Commission
so that we meet the same standards of safety like a hospital and provide the convenience
of an office setting. This is something that I think would most likely help you.
Now, beyond that, I still advise my patients that if you have allergies, manage the allergies.
I know you went through allergy testing but if seasonal allergies or pollen, trees, grasses,
other things that cause allergies should be optimally managed. If it’s a sinus issue,
manage the sinus issue. You have to be aware of what causes the area around the eyes to
swell. You state that your upper lid also swells. So there may be some other issues
underlying. If there is any question, you should at least see an ophthalmologist, get
a proper eye exam, maybe see a medical doctor or an endocrinologist just to rule out any
other issues that could be aggravating the situation. But generally speaking, this is
fairly straightforward and as long as there are no other medical issues concurrently,
this is a procedure that people come in and go back to work in less than a week.
So I think it’s important that you now look for qualified, experienced cosmetic surgeons
and learn about your options. There are different ways to approach this problem. I can tell
you from my perspective, this is the least traumatic, most expeditious approach where
local anesthesia, LITE™ sedation, address the fat pockets, go back to work in less than
a week, looking considerably better and having this nice long-term solution has been very
successful in a career that’s over 20 years. So again, meet with a doctor that you feel
comfortable with who will give you some guidance, show you some before and after pictures so
that you understand what their aesthetic style is and then move forward.
So I hope that was helpful, I wish you the best of luck and thank you for your question.