What can I do to improve my puffy eyes and wrinkles?
I'm only 22?
I'm 22 and always look very tired and I get severe lines when I smile.
My eyebags are puffy and look like I didn't sleep well.
A doctor suggested 10 units of Botox® under the eyes, but won't that make the bags even
more prominent?
Thank you for your question!
You’re 22 years old and you submitted two very good photos.
One with the eye at rest and one with activity where there are lines which you described
as severe.
By your question you have mentioned and suggested 10 units of Botox® and you’re asking a
very appropriate question will that relaxation involves increase in the prominence of the
bags.
So, before we discuss therapeutic options, let’s first define the issues involved that
you’re dealing with and what they are.
So let’s begin with the puffy bags.
Puffy bags as they appear in the photos are mostly due to something called lower eyelid
fat prolapse.
Lower eyelid fat prolapse tends to be genetic trait and although in many cases increases
with aging, certainly in a 22-year-old, it’s not age related.
It’s usually genetics.
We’ve had patients in our practice as young as 14 years old who had tremendous bags and
I’ve done surgery to help them.
In your situation, if your bags are something that is constant and persistent, then most
likely a definitive surgical procedure will be the solution to your issue.
I always tell patients who come in who have puffiness intermittently, in other words they
have good days and not so good days.
I always tell them that if they have more not so good days and the puffiness and persisting
and puffed forward enough that you are ready to have a procedure.
Unfortunately, a lot of people try to camouflage bags like this beyond a certain threshold
with fillers and they get themselves in all kinds of problems.
Understanding that what you have is lower eyelid fat prolapse and that you can observe
how much they are prominent and how much they dominate the appearance of your face before
you are ready to move forward with what I suggest is more definitive solution of lower
eyelid blepharoplasty.
As far as the question about the wrinkles and the use of Botox®, I can completely understand
about your hesitation.
In my practice, I am very hesitant to start people in their early 20s with Botox®, dysport
or any other neurotoxins because we want to first look at what is causing the lines to
be this significant.
When you are younger, your skin is as thick as it will ever will be and the factors that
I always ask about include that accelerate aging are two significant ones: One is sun
exposure.
If you’re spending a lot of time in the sun or using tanning beds or things like that,
it is highly likely that you are photoaging your skin and you’re impacting on the quality
of the skin.
Quality means thickness.
Aging causes skin to become thinner.
You lose collagen, you lose blood supply, it’s just that the quality diminishes.
That’s why refer to sun exposure as photoaging.
The other factor I always ask about is smoking.
I think there are few things that as damaging to the body, your health and to your skin
as smoking.
Smoking generates carbon monoxide which literally chokes the oxygen away from your skin.
It generates free radicals that damage the skin and so besides doing horrible things
to your lungs or to your blood vessels, it is often reflected in your skin.
Very often, being in practice for 20 years and graduating in medical school in 1988,
I can tell you that I can literally look at a person and know that they are smoker because
of the quality of their skin.
There’s almost like a graying quality.
So if you are smoking or spending a lot of time in the sun, it is recommended that you
diminish the amount of sun exposure.
Wear sun block and of course, stop smoking altogether.
That being said, 10 units of Botox® which is going to be distributed to both eyes which
is 5 units per eye is not likely to make the bags look worse because it’s not a really
high dose.
But it is something that you might want to consider trying if you don’t have any of
the other risk factors as I described earlier.
But at the same time remember that with the Botox®, it reduces the activity of the muscle
called the orbicularis oculi muscle.
That’s the muscle that works when you are squinting.
I always educate my patients to differentiate and to distinguish between the activity of
the muscle and the lines that are formed when you smile.
When you smile, your cheek moves up and there’s an exordium effect that is almost mistakenly
thought of the activity of the muscle and people would mostly come back for Botox®
enhancement.
And when I show them the difference, then they understand that physical movement cannot
be changed with Botox®.
You don’t want to stop your cheek from moving up.
So it’s about diminishing the activity.
So I think that getting additional opinions and certainly exploring the risk factors that
might be accelerating the action of your skin are very important.
So meeting with more than one doctor and getting some additional opinions would probably be
helpful with you in understanding the situation with your eyes.
So I hope that was helpful, I wish you the best of luck and thank you for your question!