Thank you for your question.
You’ve submitted several photos and you're stating in your question the challenge that
you are facing in this – in this situation where you have prominent bulging eyes but
you have been cleared of any thyroid-related eye disease.
And in the desire to get addressed puffy under-eyes, you have been getting several opinions.
Particularly, you had an opinion where it was advised that you get Restylane; another
one for transconjunctival blepharoplasty; and last was to do some kind of a fat transfer
procedure into your tear troughs.
Well, I can certainly give you some guidance.
I am a board certified cosmetic surgeon and fellowship-trained oculofacial plastic and
reconstructive surgeon with extensive experience in thyroid eye disease and prominent eyes.
And I’ve been in practice in Manhattan and Long Island for over 20 years.
And I can certainly appreciate your confusion.
Patients like yourself come to our practice everyday with very similar situation of confusion
by getting different opinions.
You see this is just the realities of clinical medicine is that every doctor comes to the
table with a belief system based on their experience.
And a lot of times that experience may have certain limitations which is why they may
push you in one direction or another.
So it’s very important to understand what are the variables that are important to address
in your anatomy that lead someone like myself to make a recommendation.
And what are the risks of these options.
So let’s start with the least invasive, at least by terminology, the Restylane.
Restylane, I think, would not make – be a good idea for you.
I think that, with due respect to the colleague who recommended this, they may be under the
belief that if they augment the areas adjacent to the fat pockets that the fat pockets would
be less obvious.
They may feel that if they did traditional eyelid surgery which means doing an external
incision, that they would potentially create a retraction.
That’s can be – can also be set about doing an internal approach.
So they may be afraid that if they’re non-surgeon, then they’re not going to do surgery and
they’re going to recommend fillers.
And if they are surgeons, they may feel that the technical aspects and the experience with
prominent eyes puts maybe a risk which they’re not interested in taking in terms of that
situation.
So I’d advise against the Restylane.
We see patients all the time who get Restylane in a similar situation or any hyaluronic acid
filler and we end up using hyaluronidase and dissolve the heck out of it.
And just getting rid of it so that we can start from scratch.
To address the fat transposition idea, it has certain merit.
But when you have prominent eyes taking that fat and then moving it into the valley of
the tear trough, doesn’t quite make sense to me logistically.
The bulge of the eyeball itself is going to be hard to hide and then you're going to create
bulk in space that’s very limited.
And I think it could potentially also create other problems.
People always – or very often have problems with lumpiness and even with eye restriction
and fat transposition has been fading amongst colleagues who quote “discovered it” a
few years ago even though this same idea has been recycled over and over.
There’s some value to it but there’s a very limited indication for it.
So as you might conclude, I would recommend a transconjunctival blepharoplasty.
The key to it in my practice, the way I do things, is to try to avoid that the scenario
where you could potentially get eyelid retraction.
And technically, it is more difficult to work when the eye is so prominent.
So someone like myself whose had extensive experience helping people with thyroid eye
disease, I am not bothered by that and I’m able to work around the eye in a way that’s
safe and minimally traumatize the area and address the fat pockets once and for all.
I think that you would have probably the best result and that you would take away the negative
of the bulging that’s causing the distress that you're experiencing.
And once you take that away, your eyes will not have the puffiness.
Now there may be a role for complimentary procedures.
A lot of times when we take our patients and we’ll actually add volume to the cheek in
a – using a method called the Y Lift to kind of balance out the shape of the eye and
the relative position of the cheek or even add volume in the central part in a way that
helps balance things out.
Again it’s a matter – it’s not – it is one not – one approach that applies to
everyone.
My general style is to first, for someone like yourself, I would actually do the surgical
procedure first and see how you feel.
And then if you like it and you're satisfied, you're done.
And I think that transconjunctival blepharoplasty would be my recommendation to you to address
your concern.
And I think would be the most straightforward and with the quickest recovery and the least
amount of management needed afterwards.
Now whether you use fillers or you do a transposition, there’s going to be some follow up that
needs to be done.
And then, of course, with Restylane, you have to do it again and again.
And although that might be acceptable for a lot of things, I don’t think it’s indicated
in this situation.
So with that being said, I hope that was helpful.
And I wish you the best of luck.
And thank you for your question.