Am I in need of a blepharoplasty procedure for my under eye area?
I was advised by a surgeon that I need to remove my under eye bags. Is this the best
choice for my case or going for fillers are a better option? My sister had done filler
before for the tear troughs but it was overdone and her under eye area seemed to be more protruded
and swollen all the time.
Thank you for your question!
You submitted a photo with your eyes looking upward and you asked a very good detailed
question. You’re asking if blepharoplasty for your under eye bags is appropriate and
you also want to learn more about fillers and you described a situation where your sister
had filler done for her tear troughs and unfortunately, it created a swollen undesirable look that
naturally, it makes sense that you’re concerned about. So I’ll share with you my approach
to helping people who complain about under eye bags.
I’m a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for
over 20 years. I’m a specialist in eyes when it comes to complex eyelid surgery, reconstructive
eyelid surgery, revision eyelid surgery and so under eye bags is one of the most common
things we deal with. For many years, the approach to under eye bags has been very straightforward.
It was always a surgical option. Then with the development and continuous expansion of
the use of hyaluronic acid fillers, an additional option became available to help soften the
appearance of under eye bags. Naturally, there are many people who are averse to surgery
as well as a lot of doctors who are versed to referring people for surgery.
And so unfortunately, a lot of people who are not good candidates for fillers to camouflage
the puffy bags end up with a distorted appearance. Now this may not be the case for your sister.
She may have mostly have hollows. You see when we use hyaluronic acid fillers to fill
hollows, it’s wonderful but again, there’s an art to it. There’s a strategy and there’s
a challenge. Everyone responds to hyaluronic acid filler differently. You see, when hyaluronic
acid fillers were originally used, it was used mostly for areas where the skin was thicker:
the nasolabial folds, the lips. But when you apply it to the under eye area, the potential
for irregularities, swelling, lumpiness became more likely because of the nature of the technical
aspect of the placement, the viscosity of the material and the amount of swelling. So
we routinely follow our patients kind of closely when we do this as an option.
To answer the question about the puffiness, in your situation, at least from the photo
you submitted, you are likely to be a candidate for lower eyelid blepharoplasty. I always
teach my patients who I make this discussion that if the fat pocket which is moved forward,
and this is called lower eyelid fat prolapse, which means the fat that’s normally around
your eyes pushes forward, creates this bulge and the term we call it is herniated fat,
if that herniated fat is beyond a certain threshold, then no amount of filler will camouflage
it adequately and in fact, it can actually make the bags look more prominent.
We use an enzyme called hyaluronidase to help patients who come to us from everywhere who
become bloated. And once they become like that, they don’t want to go back to their
doctor and they come to us and we use hyaluronidase to dissolve it. And sometimes it takes more
than one session to be able to accomplish the endpoint to where you actually see their
actual anatomy.
So in your situation, you’re young and you have puffy bags under the eyes, we routinely
do a procedure called transconjunctival blepharoplasty. What this means is we’re dealing with the
fat pockets from the inside of the eyelids. By doing this from the inside of the eyelids,
there’s no external incision and there’s no sign that you had surgery. The key to all
of this is doing it a very strategic way, in a very artistic way and doing it in a way
so that you can recover quickly.
In our practice, we routinely do this procedure under local anesthesia with LITE™ intravenous
sedation. That means you’re not under general anesthesia. You get an IV or an intravenous,
you are given an equivalent of a liquid valium and you are able to relax while in this area
we work on. We do the procedures in our own office operating facilities which are certified
by the Joint Commission. Joint Commission is the body that certifies hospitals, surgery
centers and they set standards for patients safety which are naturally we are all for
because this is an elective cosmetic surgery and you want to do this in the safest way
possible.
So with that understanding, I recommend that you meet with qualified experience cosmetic
surgeons. Coming from a specialist background, I can tell you that there are many complexities
to eyelid surgery that are under appreciated by general plastic surgeons, board certified
plastic surgeons who have a more general training scope when they do their residency in terms
of the majority of their residency experience.
So basically, finding the right specialist who you feel comfortable with, who you feel
will be able to deliver a great result and you can get a sense by looking at their before
and after photos. I’ve been in practice for over 20 years, my patients appreciate
seeing how many of these surgeries I’ve done and before there was digital, we have
big albums which people sit and look thumb through those results and try to match their
appearance with appearance of patients in the book. Once you feel comfortable, I would
suggest moving forward. It’s a great procedure. I always say that if there’s one procedure
that’s someone going to do in their face in their entire life, it will be to address
the under eye bags. There’s a dramatic effect on the overall facial appearance. It’s almost
like doing a facelift in many ways.
So I hope that was helpful, I wish you the best of luck and thank you for your question!