What's the best way to fix my under eye bags? 21 year old
As you can see from the pictures, I have a negative vector. My right eyelid is droopy
and there are prominent wrinkles under my right eye and eye bags on both eyes. What
in your opinion is the best choice of surgery (including the method) to deal with my problem?
When I pull both eyes to mimic an eye lift (as if a doctor cut a small piece of skin
and just sewn it together) I see a huge nice difference however there is still some color
to the eye. Thank you for your time!!
Thank you for your question!
You're 21 years old and you stated very well in your question that you have a negative
vector, you have bags under your eyes and wrinkled skin. And when you maneuver your
upper eyelid upward, you see a significant improvement. And you want to get some specifics
as to what type of surgery is right for you.
Well, I appreciate very much that you recognize the concept of negative vector. Basically,
negative vector means that your eye is very prominent compared to the projection of your
cheek. And as a specialist in cosmetic oculofacial plastic surgery, I've had many patients who
come from all over the world to have me repair lower eyelid retraction who have had a very
similar situation where they had a negative vector. The plastic surgeon when in and removed
fat and skin and the eyelid became averted or ectropion and developed something called
eyelid retraction. So it is very important that you understand what type of procedure
is best for you and there are advantages and disadvantages to a couple of different approaches.
What I can't do in this discussion is of course do a physical exam. So I'll discuss with you
some scenarios.
First of all, at 21, yes you are young to have this but in my practice, the youngest
person I ever did lower eyelid surgery for was a 14-year-old boy who had very prominent,
big bags under his eyes. Everyone in school was teasing him for being on drugs. So it
is certainly fine to have a lower eyelid blepharoplasty. One thing that I would probably recommend
with the understanding of your age and the negative vector is the approach I would use
most likely would be something called transconjunctival blepharoplasty. This means that I would approach
the fat pockets from the inside of the eyelid avoiding any comprise to the skin as well
as to the muscle that's below the skin. This means that the support of the eyelid remain
intact.
Now, the next question is: how do we make sure that the tone of your lower eyelid which
you try to create by lifting can be approximate to what you do there. It has to do a lot with
the fact that you have something called lateral canthal tendon laxity. Lateral canthal tendon
laxity may be a factor. I should say that you have that but judging by the position
of your lower eyelid, it is clear to me that there is probably there is some laxity or
if there's a history of allergy and eye rubbing then certainly, there is some tone that needs
to be restored. The procedure to restore that is something called lateral canthoplasty or
a lateral tarsal strip to be very specific of the technique but something that I can't
tell you is whether or not it is indicated or appropriate is whether you need some type
of graft of spacer graft in order to give you some vertical support. That is something
that requires physical examination.
With that being said, it is important for you to explore your options and go to several
experienced specialist. People who do a lot of lower eyelid surgery for complex eyelid
procedures and have a lot of options to offer you so that you feel that the doctor knows
how to handle any issues that may occur with the anatomic issues that we have mentioned
before particularly the negative vector. An experienced surgeon should be able to help
you get an improvement of the overall appearance.
Something that I would also mention to you is that we employ something called platelet-rich
plasma for a lot of our patients to help with the hollowness or dark circles, to improve
the skin quality to again, improve the appearance. At 21 years old, without a history of allergies
and other factors, I can't make that recommendation specifically. But certainly, to summarize,
you have to understand the factors that are important to maintain. That includes the tone
and the fixation of the lateral canthal tendon, the outer corner of the lower eyelid and lifting
it up or tightening it to reinforce it as well; I would avoid removing any skin. That's
something that may seem logical but that's likely that's necessary. At 21, you probably
don't have any extra skin. As well as the support of the lower eyelid at an internal
aspect, the vertical support. And last but not the least, about the skin quality, using
modalities such as platelet-rich plasma. I know that's a lot to digest but I think that
should help guide you as you do your research and meet with doctors. So I hope that was
helpful and thank you for your question!