Thank
you for your question.
You submitted your question with a close-up view of your eyes. And you’re asking is
it better for you to have surgery or to have fillers. And you state that you have had under
eye bags since as far as you can remember, that both sides of your family have these
characteristic eye bags and dark circles. So you’re trying to figure out what’s
the best way to approach your situation and you’re 24-years-old.
Well, I can certainly share with you the concepts I apply to my practice when I meet patients
like yourself every day in my office. A little bit of background, I’m a Board-certified
cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have
been in practice in Manhattan and Long Island for over 20 years. Helping people with their
under eye bags with surgical and non-surgical solutions has been the core of my practice
for years. And it has certainly evolved over time with new technologies and newer strategies
which is of course why this is a point in time where you can ask a question between
surgery and filler.
So let’s understand some basic concepts. First, what is it you are dealing with. You’re
dealing with a condition called lower eyelid fat prolapse. Lower eyelid fat prolapse means
that the fat that’s normally around your eyes pushes forward and creates these bulges
under the eyes and that’s referred to as herniated fat. In the modern world, over the
past many years, the concept of helping camouflage the lower eyelid fat has certainly been a
very useful tool in our practice to help patients who have a minimal or moderate amount of fat
but it depends a lot on the anatomy, the bone structure and this is very important.
So when someone has a certain amount of limited fat prolapse pushing forward and they have
a certain amount of projection to the bone under the eyes, then you can fill that space
at the tear trough with fillers such as a hyaluronic acid filler in the Restylane or
Juvederm family and that can help buy a lot of time.
When I look at your photo and in the absence of a physical examination and looking at the
relative projection of your cheek, my leaning is more towards doing or approach your situation
surgically because the fat prolapse essentially is going to a level where there is not much
space to actually place a filler.
Further, in order to try to blend that area, I can tell you from patients who’ve come
to my office after having this done, a lot of times patients will get filler then they’ll
get more filler placed on the front of their cheeks in order to blend with this bulge of
fat and that ends up being very much counterproductive. Very often, that’s done by non-surgeons,
by doctors who cannot perform lower eyelid surgery.
Now of course at 24, you might be hesitant about doing a surgical procedure. Certainly,
we have dealt with this a lot over my decades of practice. In fact, we recently helped a
young woman who was 19-years-old and had a similar type of situation. Basically, the
approach in our practice is to do the procedure such as in your situation called a transconjunctival
blepharoplasty. Transconjunctival blepharoplasty means that the fat pockets are approached
from the inside of the eyelids. Years ago, I had advocated this procedure particularly
for darker skin types and that was after noticing a lot of people who have darker skin that
means anybody with an olive complexion or darker were getting surgery where incisions
were made on the lower eyelid and they were not having good outcomes with the scars and
their lower eyelids were becoming retracted and that was particularly true in people who
had very prominent eyes. So by doing this procedure from the inside of the eyelid, I’m
able to preserve the anatomy of the muscles that are critical for maintaining the eye
shape and aesthetics as well as function. And in so many ways, it’s as minimally invasive
as you can get with surgery and still get a real outcome to address the underlying issue.
Now further in our practice, we do our procedures with local anesthesia and LITE™ sedation.
And we do it within our office, in our Joint Commission approved facility. So for many
patients, patients who come to us from all over the world for this procedure, they like
that they don't have to go to a hospital or surgery center and they can comfortably have
the procedure done and be discharged without having to go under general anesthesia.
Further, it is routine for us to also use something called platelet-rich plasma (PRP)
to help with those dark circles under the eyes, to help some of the skin quality. At
24, it may not be as critical but it might have some potential benefit at least at the
time of surgery. I find it to be very versatile and useful. It’s derived from your own blood
and it contains the wound healing and growth factors that help address skin quality and
dark circles.
Now as far as the future is concerned even after you get the puffiness reduced, you may
want to consider other things such as fillers depending on your bone structure. So when
you ask a question like whether or not to do surgery or fillers, I often take the photos
of my patients and I take them from all angles. I try to explain to them that once you get
past the puffiness under your eyes, well if you need a little bit of volume in your cheeks
or anywhere else in your face to help create harmony, that might be something worth considering.
Generally speaking, younger people like yourself, at 24, that’s not really an issue but I
want to at least mention that in case there is some other potential opportunities that
you may want to address.
So I think it’s very important for you to get a proper evaluation by a qualified, experienced
cosmetic surgeon who performs lower eyelid surgery a lot and is comfortable with dealing
with all kind of skin types and is very good, in particular, the transconjunctival approach
from the inside of the eyelid. And I think you’ll find that doing this will make a
real big impact. I have to say that in years and years of practice that helping someone
with under eye bags is one of the most satisfying things that we do. The patient’s entire
face is like getting a facelift. The face opens up and brightens up. So, I think this
is worth pursuing just find a doctor you’ll be comfortable with.
So I hope that was helpful, I wish you the best of luck and thank you for your question.