I'm 42 yrs old and have under eyes puffiness and dark circles.
What treatment would you recommend?
Hi all!
I am 42 years old.
I have had puffy eyes and dark circles as far as I remember, but it has become much
worse.
I am considering eye lid surgery.
The only thing is that sometimes the puffiness becomes much less and my eyes become bigger
and nicer and the black line is also easy to cover!
(this doesn't happen very often, maybe once a year for a couple of days).
If it is a permanent fat under eyes, why does it sometimes become less?
If I get the lower eye lid surgery, would I still get puffiness?
Thanks
Thank you for your question!
You're 42 years old and you submitted some very useful photos to describe your main concern
which is puffiness under your eyes and your dark circles.
You mentioned in your question that there are times when the puffiness is better and
that it's easier to conceal the dark circles.
And you want to know can the puffiness come back after surgery.
As a cosmetic oculofacial plastic surgeon for 20 years, practicing in New York's Upper
East Side and Garden City, Long Island, you can appreciate that we see this type of issue
everyday in our practice.
So, I'm going to begin helping you with your question by first answering some of the things
that need to be answered first.
Number one is what is the puffiness.
The puffiness is caused by something we call lower eyelid fat prolapse.
Lower eyelid fat prolapse means the fat that is normally around the eyes will push forward
and in some studies, it has been shown to actually increase in volume.
When it pushes forward, it creates a bulge and that bulge is like hernia that's why we
call it herniated fat.
The strategy for treatment for herniated fat is to do some type of procedure to reduce
and sculpt as well as reposition.
The other side of this issue is of course the dark circles.
Dark circles under the eyes are typically a combination of genetics as well as pigmentation
that is ethnic, sun exposure or environment changes and as well as the quality of the
skin that is so thin that you can actually see through the skin and see the blood vessels
as well as the muscle underneath.
And sometimes in people with cases of allergies, it will be dark in a term we refer to as allergic
shiners.
So with that understanding, let's also appreciate as to why there is variability in puffiness.
It is very well known that the fat pockets under the eyes are affected by fluid in terms
of the fluid that is important in the response of the body in situations such as allergies
and sinus issues where there is some back-up of fluid.
Sometimes people would have food sensitivities, lack of sleep will cause puffiness.
So when we're talking about that type of puffiness, we're talking about fluid as opposed to volume
caused by anatomy of fat.
So in a situation like yours and this is in the absence of a physical examination, we
would typically do a transconjunctival blepharoplasty.
Transconjunctival blepharoplasty involves the strategic reduction of fat pockets from
the inside of the eyelid, avoiding an external incision as well as repositioning and sculpting
as appropriate.
When we do this, we also combine this with a concept of PRP or platelet-rich plasma which
is drawn from your own blood to help accelerate the healing the process.
When we deal with the dark circles under the eyes, we typically will first do the first
do a platelet-rich plasma treatment under the skin to improve skin quality and we will
also combine that with a procedure like fractional CO2 laser.
The combination of treating the physical volume as well as the skin quality yields very nice
results that our patients really appreciate.
To answer the question about puffiness afterwards, I always tell my patients that they still
have to manage fluid.
And so, it's your allergies, treat your allergies.
If it's sinuses, treat your sinuses.
If it's salt intake or other certain type of food that might cause the fluid to occur,
then you might need to be careful about adjusting your diet.
That being said, the fluid that causes the puffiness to be pronounced as it is now in
the presence of the fat pockets rarely ever is the same level as you are experiencing
when the fat pockets the way they are.
I think that you will benefit from a surgical procedure and at this point that you meet
with qualified experienced cosmetic surgeons who have a lot of experience with eyelid surgery
who could guide you further.
The thing that we can't do in a discussion like this is a physical examination.
So, judging from the integrity of the lower eyelid tone, the canthal tendons and the skin
quality is a 3-dimension experience.
So I think at this point, I think you should meet with the doctor but I think that judging
from the photos, I think you would benefit from a surgical procedure with the combination
of these other things such as PRP and fractional CO2 laser.
And I think that regardless of the amount of fluid you can get afterwards related to
other issues, you would see a benefit.
So I hope that was helpful, I wish you the best of luck and thank you for your question.