Hollowing after eyelid surgery?
If I can't use facial fillers, what are the other options I have for these results after
eyelid surgery?
I'm 5 months out now and the sunken look seems to be getting worse as time goes by.
Thank you for your question!
It's five months since you had your eyelid surgery and you're very concerned about the
hollowing of your lower eyelids.
the photos you submitted have been very helpful because you submitted different pictures in
different light.
I'll share with a little bit about my approach to addressing what is often perceived first
as hollowing under the eyes.
Well, not seeing your preoperative photos, assuming that you had significant amount of
puffy bags under your eyes that you need lower eyelid blepharoplasty.
I can also tell you that the lower eyelid position looks very good.
I think that the goal of the lower eyelid blepharoplasty was essentially accomplished
which was to take away the negative of the bulges of fat underneath the eyes.
In my practice, I first give the patient a general overview of the overall changes.
I wrote a book a few years ago called "The Fine Art of Looking Younger" and it was based
on the idea that people need to understand that facial aging or genetic changes are a
combination of volume loss and sagging or descent.
Very often if someone comes in and has bags under their eyes, if they happen to have cheeks
that look flat or there's a lot sagging, I bring to their attention that the area of
their eyes do not change in isolation.
This is an exception when we talk about somebody who is in their 20s or younger.
But for a lot of people who come for this procedure, who are in their late 30s or beyond,
volume loss is a very significant part of the overall look of the person's appearance.
The challenge is, if we a problem such as bags under the eyes, we focus on that and
we literally magnify it and we don't look at anything else.
So what I do is that I bring this to the attention of my patient and explain that if after the
surgery, if they have any concern about relative hollowing under the eye, we would address
certain key anatomical elements that are associated with the perception of hollowing.
These elements include the tear trough area and that area is very important when it comes
to the overall appearance of the eyes look good.
The area of the eyelid-cheek junction sometimes called the V-deformity and that's at the rim
at the lower part of the eyelid.
When we are younger that area has a volume and has layer of fat and a little cushion
there.
Genetically when people are young or with age, that area becomes depleted and you start
to see an effacement or an revealing of the bony structure.
And there's the malar or the sub-malar space.
Those areas can be very flat.
So my typical strategy for the tear trough area and the V-deformity area is combine hyaluronic
acid such as Restylane with platelet-rich plasma.
Platelet-rich plasma is derived from your own blood.
It is blood that is spun down like from a typical blood draw when you do in a lab.
We spin the blood down and we concentrate the platelets and the growth factors that
are responsible for healing.
We have seen a very nice synergy in the quality of the skin, the volume correction and the
overall look with this combination of hyaluronic acid with platelet-rich plasma.
Certainly hyaluronic acid alone is a perfectly good filler.
Very often our patients are little frustrated to do this as maintenance but when you are
dealing facial changes, not everything is surgically correctable.
That's why there's role for fillers and other things to correct volume.
In the malar and sub-malar area, we can do things such as fillers such Radiesse or fat
transfer as wells as more permanent procedures such as placement of sub-malar implants.
Every patient has to be evaluated individually and there has to be communication to get a
sense of what other things are bothering them.
I would advise you not to do anything to treat the concavity or the area from the eyeball
to rim which you may feel as hollowed because frankly, a lot of people have tried procedures
such as fat transfer in this area.
Unfortunately, because of the variability of healing, fat transfer can result in chronic
swelling a lot of irregularities.
That's from my experience.
People have come to me from all over the world with fat transfer where there were nodules
and bumps where they just want to get rid of them.
It became a very complex procedure to try to get improvement.
I think you need to communicate with your doctor who did your surgery and discuss your
concerns about the healing.
I think your doctor has heard this problem before and has some ideas about how to address
them.
Again, think about volume restoration, think about the strategy for that restoration and
think outside of the immediate area of the eye where you had the fat pockets reduced.
Think about the eyelid-cheek zone as the tear trough and the cheek area.
I hope that was helpful and thank you for your question!