Thank you for your question. You’re 24-years-old, you’re a Filipino descent and you have submitted
several photos that are very helpful and you describe in detail how you have some issues
with dark circles under the eyes as well as the presence of bags under your eyes particularly
when you smile. So you are looking for some guidance as to deal with this concern. Well
I can certainly assist you.
I am a board I’m a board certified cosmetic surgeon and a fellowship trained oculofacial
plastic and reconstructive surgeon practicing in Manhattan in Long Island. Under eye bags
is something I have been helping people with everyday in my practice for 20 years. So I
think that there is an opportunity for you to become more educated as to the definition
of your concerns whether or not it’s appropriate to seek some type of solution.
So when people come to us for under eye bags more commonly the bags are there constantly
regardless of facial expression. And when that’s the case like when the face is relaxed
and you see bags that are usually caused by something called lower eyelid fat prolapse.
What that means that the fat that’s normally around the eyes pushes forward and creates
this bulge of fat and it is routine for us to address this fat packet with local anesthesia,
LITE™ sedation and most routinely we do a procedure called transconjunctival lower
eyelid blepharoplasty. Now when someone like yourself presents to our practice and has
this type of problem where they don’t have bags when their face is relaxed but do have
what they perceived as bags when they are smiling, well most likely this is caused by
the contraction of a muscle called the orbicularis oculi muscle. Now this is a muscle that supports
the eyelid. It is responsible for the position as well as for blinking. So when you smile,
it’s like contracting a bicep muscle. The muscle bunches and the skin bunches with it
and it results in what you perceived as a bag.
Now when people have come to us with this concern and they say they really don’t like
it. I’ve always shared with them the importance of this particular muscle at baseline for
proper eye lid position and if this muscle were let’s say for example relaxed with
Botox™ it is possible to get some improvement but in order to keep the balance where the
muscle tone is still there to provide proper support, it may not be dramatic enough to
justify the cost and the trouble of doing these procedures over and over but I think
that the majority of our patients who I explained this to that at least feel that they understand
why they have this type of ridge under their eyes.
Now from my perspective as an artist, as a cosmetic surgeon I don’t find these types
of issues to be aesthetically a problem. I think that it’s part of the look when someone
smiles to have the bunching when that occurs and of course a smiling face is always an
attractive face from my perspective. So I think that you could consider experimenting
with using some Botox™ or Dysport to see if that muscle tone can be improved but I
think I’m always hesitant and more conservative when dealing with people who are younger like
yourself and requesting some type of procedure where how practical is it for you to do this
with your lifestyle and it is of course different when someone enters mid 30s and beyond but
in your early to mid-20s, I think it might be a little bit of a challenge to justify
the expense and the trouble but that’s a personal decision.
As far as the pigment is concerned just for the completeness, it’s essentially genetic
trait and since you are young I would not usually do for people who have dark under
eye circles or hollows where I use something like a platelet-rich plasma (PRP) which is
derived from your own blood as you need to stimulate your own skin and improve skin quality
or combine that hyaluronic acid with platelet rich plasma to help with under eye hollows
which you don’t have.
So again with genetic issues as well as functional normal issue and in the context of being young,
I’m really hesitant to suggest you pursue aggressive treatment. Certainly I think it
is appropriate to meet with qualified experienced doctors but at least remember that whatever
suggestions are made, you have to think of its sustainability. If you want to experiment
and see what happens, I think drugs like Botox™ and Dysport are safe and can be worth just
to satisfy the curiosity but otherwise, I just think that you would probably be better
of waiting than to do anything for a few years.
So I hope that was helpful. I wish you the best of luck and thank you for your question.