Thank you for your question.
You submitted your question with a photo.
And you are asking basically, how to treat the aging changes in your under eye area.
You describe in the details of the question that you have been unhappy with the last two
times you had filler placement placement because you were left with the area looking lumpy.
And in addition, you are concerned about the skin getting loose under the eyes.
Well, I can certainly share with you my approach to patients like yourself who come to my practice
every day.
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 under eye aesthetics with a wide range of strategies and techniques including surgery,
laser and injectables have been the cornerstone of my practice throughout my career.
And I can certainly help you appreciate the strategies and what the logic behind the strategies
are.
So to begin with, there may have been a point where you noticed some relative hollowing
that seem to be amenable to the placement of filler which is why you were doing that.
And essentially, that has become a very significant option for many people who are experiencing
something called lower eyelid fat prolapse which means the formation of these under eye
bags due to the fat around the eyelid pushing forward is to place an injectable filler in
what’s called the tear trough.
And it is certainly a strategy that I employ pretty much every day in my practice to help
patients who want to look good for an upcoming event or recognize that they’re going to
have surgery or want to have surgery but they don't have time.
And it’s essentially, the strategy is also contingent upon the level of prolapse of this
area, of the fat.
But what is also important and I think you have discovered is the tissue quality.
When the skin is thinner, then the strategy of using filler becomes a little more complex
because the skin can become, as you have observed, lumpy.
What I would say is that, when I look at a patient and I evaluate their eyes, I also
look at the whole picture.
I look at the whole face.
And I think it’s important that you take that perspective to understand that facial
aging is not limited to just the eye area but look at how the global facial area is
impacted.
In particular, I would say notice the cheeks.
A lot of times, people are focused on the narrow zone of the areas of their eyes and
don’t realize that cheek volume has also diminished.
So when I do an evaluation, I look at both the eyes and the cheek.
Now that being said, a strategy can certainly be employed to address the under eye area
as well as to address the skin quality.
So what is routine in my practice is to do something called transconjunctival blepharoplasty
or lower eyelid surgery from the inside of the eyelid to address the fat pockets that
have pushed forward and have created this contrast between the bulge of the fat and
the hollow of the trough which is where you are having the fillers placed.
By addressing the puffiness, the trough does not look as obvious.
In addition, we routinely combine that with a strategy of using regenerative medicine
technology using something called platelet-rich plasma (PRP).
Platelet-rich plasma (PRP) which is derived from your own blood helps stimulate collagen
which is so important to address skin aging and is very useful and helps with both the
collagen volume of the skin as well as discolorations and fine lines.
In addition, we routinely do something called fractional CO2 laser or fractional Erbium
laser to help with the epidermis as well as the dermis to help improve the skin quality,
to improve some of the perception of looseness.
It’s very important to understand that the laxity you’re feeling is not really representative
of excess skin.
There’s a distinction that’s very important to be made.
There’s a difference between skin quality and skin quantity.
And many times, people get in trouble when well-meaning plastic surgeons take away skin
in attempt to tighten the lower eyelid which results often in lower eyelid retraction or
ectropion and we don't have to go there.
I think it’s important to recognize anatomy, as I described, to understand the approach.
So meet with qualified, experienced cosmetic surgeons who have extensive understanding
of the eye area and discuss the options that may be useful for you and see what makes sense
to you and move forward.
But understand the different elements.
There’s the anatomy of the fat, the anatomy of the skin and the anatomy of the face and
the cheek that are all very important to have in harmony so that you get a nice outcome.
So I hope that was helpful, I wish you the best of luck and thank you for your question.