Is there anything I can do for the bags under my eyes before October?
I am getting married in October. I have had bags under my eyes for as long as I can remember
- but in the past 2 years, they have gotten significantly worse. I was wondering if there
was anything I can do for them that will not show in the wedding pictures in October. Of
note is that I may have an undiagnosed autoimmune/autoinflammatory or connective tissue disorder - my skin is
paper thin, and I sometimes am prone to hypertrophic/keloid scars. Thank you for any ideas or help!
Thank you for your question!
You submitted two photos, one with your face relaxed and one with you smiling. And you’re
asking a question about the under eye bags and you want to time this before October which
is a few months from now regarding your wedding and that you also described that you have
a possible diagnosis of an autoimmune inflammatory type of disease which you state is actually
associated to the degree of your skin being paper thin and a propensity for form thickened
scars.
So certainly, as a practicing cosmetic surgeon specializing in oculofacial plastic surgery
for over 20 years, the wedding deadline is absolutely something I’m no stranger to.
I often tell my patients about a woman who we operated on years ago who I did her upper
lids, lower lids, face and necklift 10 days before her son’s wedding. And fortunately,
things worked out but that was a lot of anxiety and I wouldn’t encourage that type of timing.
I would say that for the puffiness under your eyes that you have what’s called lower eyelid
fat prolapse. Let’s begin with defining the problem. Now having lower eyelid fat prolapse
means that you have a hernia, a fat that’s normally around your eyes pushing forward
and creating these bulges. Now the good news is that you don’t have to have surgery where
you have to have an incision on the outside. This is a very important point. For years,
a lot of people of different ethnic backgrounds or darker skin were external incision surgery
where the surgeon would make the approach to the lower eyelid to a transcutaneous approach
which means going from typically an incision under the eyelashes, getting to the fat pockets,
removing skin and then closing. What can happen are a variety of issues but just seeing a
scar that’s obvious is very undesirable.
For many of those patients, I wrote an article years ago called “Ethnic Considerations
in Eyelid Surgery” and it was clear that for people who have issues with their skin,
in my hands and in my practice, I also recommend an approach called a transconjunctival blepharoplasty.
Transconjunctival blepharoplasty means we’re working from the inside of the eyelid. And
so even if somebody is a keloid former or they have a type of autoimmune disease or
collagen vascular disease, we’re able to minimize the trauma by working from the inside
of the eyelid. Now by doing that, we are able to address the fat pockets and avoid making
an incision on the outside. So to answer your question from the perspective, you don’t
really have to be worried because when we work from the inside, it’s infinitesimal
the possibility of having some type of scarring issue and therefore, in my hands it’s a
very safe approach, very predictable approach.
As far as timing for the wedding, I like for patients to take as many months as they possible
can before their wedding to do a procedure like this. The earlier, the better. Can we
do this as short as a couple of weeks from the wedding? Yes, it’s possible but there’s
always a possibility that you can have some fluid and some swelling and sometimes, it
has nothing to do directly from the surgery but from maybe concurrently occurring, allergies,
sinus issue and other things than can cause fluid to collect around the eyes. So, the
sooner you do the procedure, the longer time you have before this deadline. So I think
that given that October is only a few months away, you should be able to be fine for your
wedding and look good for your pictures. I always tell patients who are in a similar
situation that for women, they’re going to be wearing makeup and they’ll probably
look fine any way as long as they’re good about following post-operative instructions
and managing sinus and allergy issues if appropriate or necessary.
So I think it’s very important that you find and meet with experienced, qualified
cosmetic surgeons who specialize in eyelid surgery. I think there is of value to super
specialists who do this type of work. That’s always in medicine that you always find people
who do a lot of certain things but that’s again a personal bias as a specialist. But
I think that once you find someone you’re comfortable with, you review their before
and after pictures, you feel good about their style and the way they do surgery, then move
forward.
Another thing that I should’ve mentioned is recovery time can also be facilitated.
In our practice, we do these procedures under local anesthesia with LITE™ sedation. This
way we avoid general anesthesia which adds another variable in terms of recovery. People
tend to take longer to recover from general anesthesia and there’s higher risk involved
with general anesthesia. So in our practice, we have patients who come from around the
world and have patients who have hard deadlines and are always in some type of urgent situation
where they need this type of surgery done sooner rather than alter, these types of steps
such as in office, local anesthesia, LITE™ sedation, in a facility that’s certified
by the Joint Commission so safety standards are always kept to the highest level, patients
are able to recover quickly and are able to move on with their lives and think of more
important things.
So I hope that was helpful, I wish you the best of luck, congratulations on your wedding
and thank you for your question!