Have dark puffy circles under my eyes, in addition to major asymmetry issues. Suggestions
to improve look of my eyes?
Thank you for your question!
Your question, you state simply that you have dark puffy bags under the eyes and you’re
asking for guidance on what to do. So, let’s start by understanding the anatomy issues
because there’s one explanation for the puffiness and another explanation for the
darkness.
As a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for
over 20 years, this is a problem we deal with every day. So let’s start by learning what
is causing the puffiness. The puffiness under the eyes is typically a hereditary issue and
it’s called lower eyelid fat prolapse. This term refers to the fact that fat is normally
around the eyes and pushes forward, prolapses and herniates or creates a herniated prolapse
and so we refer to it frequently as herniated fat. Addressing this fat needs some type of
surgical procedure. There have been different non-surgical modalities introduced which have
all failed completely. They simply don’t work. There is some benefit of fillers in
patients who have some slight bit of fat coming forward but for most people, once they’re
seeking attention, they have too much fat moving forward.
In our practice, we routinely perform a procedure called a transconjunctival blepharoplasty.
This means that what we’re doing is we’re addressing the fat pockets from the inside
of the eyelid and by doing that, we’re avoiding an external scar or incision, we’re maintaining
the shape and stability of the lower eyelid, a very important factor when dealing with
lower eyelid puffiness. In addition, there’s no sign that you had surgery. What we’re
do is we’ll remove and reposition fat as is appropriate and you get this nice natural
contour as if you never had the fat pockets to begin with.
Now with dark circles under the eyes, when you look back, there are so many different
solutions. If you just look for solutions for dark circles, you’ll be hit with different
type of creams and some medical or pseudo medical devices. What essentially is the issue
with dark circles is it has to do with a combination of genetics. Some people who have a darker
complexion have a tendency to complain about dark circles. As well as environmental, when
we say environmental that includes sun exposure, smoking, eye rubbing, various types of stresses.
So, to address the skin quality or I should say the wrinkling and fine lines that occur
with the breakdown of the skin, we try to restore the skin in terms of its health and
we do with something called platelet-rich plasma. When we talk about platelet-rich plasma,
what we’re describing is deriving from your own blood, like a simple blood draw when you
get in a doctor’s office or a lab, and we spin the blood and we concentrate the critical
factors needed for healing. And when this is injected under the skin of the eyelids,
it allows the skin to kind of blossom and improves the skin quality by generation of
collagen and new blood supply. So for us, platelet-rich plasma has been a tremendous
benefit for people who puffiness or come in just for skin rejuvenation.
The other aspect of the darkness has to do with the relative contour. A lot of times
people say that they have hollows under their eyes. And a lot of times it has to do with
the anatomy. And in terms of the skin, it’s just the position with bone of the tear trough
as well as the presence of allergies or sinus issues that creates kind of pooling of blood
under the eyes and it results in a pigmentation that is referred to as allergic shiners. What
we do a lot for this is we try to enhance the volume by placement of a filler or a combination
of a fillers such as hyaluronic acid, Restylane for example and combine that with platelet-rich
plasma and we’re able to fill out the tear trough and improve the skin quality.
Someone like yourself, our strategy would be to do the puffy bags under the eyes as
a surgical procedure, transconjunctival blepharoplasty, which we perform routinely under local anesthesia
with LITE™ intravenous sedation. This way, you avoid general anesthesia altogether as
well as the use of platelet-rich plasma at the same time concurrently so that you can
not only get the reduction of the puffy bags but you get an improvement of the skin quality.
If after surgery you still have the desire to enhance the tear troughs, we can do then
the fillers of Restylane combined with PRP if it’s of any value at that point.
So at this point, I recommend that you meet with qualified experienced cosmetic surgeons
and learn about their approach. Of course, my bias is I like to get very nice results,
quick recovery and I would like my patients to very comfortable. So the find that doing
the procedures under local anesthesia with LITE™ sedation in our practice in our Joint
Commission approved facilities makes for a very convenient of seamless experienced for
them. So most of patients, in terms of recovery, are able to go back to work within a week
with minimal swelling and minimal bruising.
So I hope that was helpful, I wish you the best of luck and thank you for your question!