Thank you for your question.
You're asking if there’s scarring and discoloration after eyelid surgery.
And you write in your question that you're of African descent and then you're choosing
to undergo transconjunctival blepharoplasty but you have a concern about hyperpigmentation.
And you're asking is there a way to avoid this.
And you're also reflecting on the possibility of – are you trading of puffiness for discoloration?
Well I can certainly give you my approach – or explain to you my approach to situations
like one you're in.
I'm a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
I do a lot of cosmetic eyelid surgery and the focus on ethnic skin types has been a
significant mission in my practice for the past 20 years.
In fact I was one of the first to write articles about unique situations that are specific
to ethnic skin types as it relates to eyelid surgery.
So I will explain to you how I approach this situation and give you an explanation as to
what you're experiencing.
To understand that skin of any pigment that is let’s say darker than olive-complected
has a tendency to have inflammation – pigmentation related to any type of inflammation.
Many people with darker skin will say that if you get a pimple and they leaves them with
a blemish that lasts for months.
Now when it comes to eyelid surgery for puffy under eye bags, there’s no question in my
mind that the transconjunctival approach is the optimal approach.
For the majority of our patients who come, it’s not usually the case that it’s excess
skin that would justify going in from the outside to take away skin.
And even if there was some excess skin, I still do a transconjunctival approach and
I combine it with something else externally.
So which brings us to then what happens post-operatively.
Number one you're not going to have the bags anymore.
So that is the purpose and the desired outcome.
But what will you have in the short-term.
Most people will have some degree of hyperpigmentation.
It’s just a natural skin reaction.
Now we try to very often, even with people who are relatively young, mitigate both the
hyperpigmentation response as well as improve skin quality with something called platelet-rich
plasma.
Platelet-rich plasma is drawn from your own blood.
And what we’re doing is we’re concentrating the healing growth factors that are responsible
for wound healing.
And we found that there is actually some degree of not only improvement in skin quality but
it’s been my observation that patients tend to have less discoloration and hyperpigmentation.
Still on a case by case basis to say that you cannot get any hyperpigmentation is not
realistic.
Your skin type can get dark very, very quickly.
But let’s differentiate reactive hyperpigmentation to permanent hyperpigmentation.
So from that respect, as long as the trauma of surgery – the use of heating and other
modalities that limits this natural response, then when that’s done, and basically the
most – in the most gentle way, I would say that you're going to have only reactive and
temporary pigmentation.
I tell our patients that it is normal in the first couple of months to have some darkening
under – the under eye.
And then as the months go – continue, you will find that it basically goes back to your
baseline skin color.
In some situations, with the benefit of PRP, the skin quality looks better, and hence the
skin color looks better.
So that being said, you may want to inquire with your doctor about PRP or platelet-rich
plasma.
It’s not a very popular modality.
A lot of doctors have yet to be properly educated about this modality which already has been
established very well in oral surgery and in orthopedic surgery and in any literature
search in the National Library of Medicine will show hundreds and hundreds of articles
in the benefits of PRP.
The problem is, in the modern world where there’s so much messaging from very large
companies for a very high priced, high ticket items such as lasers and injectables, something
as simple and elegant as platelet-rich plasma gets lost in terms of knowledge and dissemination.
And physicians tend not to do something that they’re not fully trained, you know, comfortable
with and are uncomfortable with exploring.
And of course there’s also the experience.
We actually use platelet-rich plasma a lot in our practice.
We use it for acne scars, we use it for wrinkles.
We use it for scar revision.
We use it for skin quality improvement.
We even use it in combination with a material called extracellular matrix for hair loss.
So experience with PRP and understand the limits of the benefits is also important.
And so there is still room for more doctors to learn how to use this material.
But that being said, even without PRP, you will still benefit and you’ll still not
have puffy under eye bags.
And it’s not likely that would have long-term permanent pigmentation.
I think that as long as your doctor and you feel comfortable with your doctor in terms
of the skill level and their ability to deliver the results you want, you should be fine long-term.
So think long-term as far as beyond three to six months and beyond.
Short-term, you'll probably get some degree of hyperpigmentation.
So with that being said, I hope that was helpful and I wish you the best of luck.
Thank you for your question.