Bags and discoloured under eye circles.
What are my options?
Any options for treatment?
Thank you.
Thank you for your question!
In your question you described briefly eyebags and discolorations, what are your options?
Well, as a cosmetic oculofacial plastic surgeon for 20 years practicing in Manhattan and Long
Island, this is a question that we get to deal with everyday.
I would like to help you by first helping you understand what the causes are of the
puffy bags and the discolorations.
Unfortunately, there are many over-the-counter and other types of remedies which are claimed
able to treat bags and discolorations under the eyes and of course, of them don't make
much of a difference.
So we'll start first by understanding the anatomy.
Let's start with puffy bags.
Why do you have bags under the eyes?
It's typically believed that it's related to lack of sleep, fatigue, etc.
But when the fat pockets or I should say the puffy bags are there constantly, it's due
to something called lower eyelid fat prolapse.
Lower eyelid fat prolapse that the fat that's normally around the eyes, pushes forward and
in several studies, it has been shown to increase the volume and it results like a hernia.
It pushes forward, creates a bulge and it looks like you're always tired.
So, the issue there is an anatomic issue and when you have lower eyelid fat prolapse, naturally,
the first line of treatment which is usually getting more sleep and then using some topicals
and creams.
A lot of our patients come in with a bag full of all kinds of creams and as I mentioned
earlier, they don't really work because the volume that the fat pockets create actually
results in a bulge that is deeper than what can be applied on the skin.
We'll discuss addressing that but before that, let's address the discolorations.
Dark circles under the eyes is one of the most common complains and it is understandable.
There is a wide spectrum of issues related to dark circles.
Sometimes it is due to hereditary, just natural pigmentation that runs in families.
It sometimes is due to sun exposure.
The skin becomes very thin and wrinkly.
In addition, there are other factors such as allergies where the skin, you can actually
see through it and you see the blood vessels and iron deposits that are due to pooling
of the blood and it is often referred to allergic shiners.
So when we talk about dark circles for a light skin person with puffy bags under the eyes,
we have a global approach to this problem.
We begin first with the puffy bags.
Typically for a younger person or someone with good quality muscle tone and in the absence
of extra skin, we have to distinguish that there is a difference between the quality
of skin in other words being thin and stretchy versus excess skin.
We approach this problem typically by doing a transconjunctival blepharoplasty.
Transconjunctival blepharoplasty is an approach of addressing the puffy bags from behind the
eyelid avoiding any external incision as well as maintaining the integrity of the anatomy
of the lower eyelid.
What we do from behind the eyelid is reduce the fat pockets, reposition and other manoeuvres
to make it look as if the bags were just never there.
In terms of the skin quality under the eyes, we have been doing something that a lot of
doctors are not doing at this time and this is the use of something called platelet-rich
plasma.
Platelet-rich plasma is derived from your blood.
It is process where we draw your blood like a typical lab test situation and we spin it.
We spin it to isolate the platelet and the plasma which concentrates the healing factors
and the growth factors required for healing.
When we inject this material under the skin of the eyelid, it improves the skin quality
of the eyelid by improving the vascularity, the collagen and the overall health of the
skin.
In addition, in selected cases, we would do something called fractional CO2 laser.
This is basically using a technology which transfers light energy into heat to take off
the top layers of the skin selectively and to deliver thermal energy into the skin so
that there's a tightening effect.
When done in combination, the results can be quite dramatic and most importantly, they
can look very natural.
For a lot younger people have any kind of incision in a visible area can become very
obvious so a lot of our patients really appreciate this approach from the inside of the eyelid.
We do this procedure under local anesthesia with LITE sedation which is minimal intravenous
sedation.
We avoid general anesthesia.
This way, our patients have a quicker recovery.
So in terms of your options, if someone like yourself comes to our practice, just to review,
we would typically do a transconjunctival blepharoplasty combined with platelet-rich
plasma injection and possibly the use of a fractional CO2 laser for the skin quality
improvement.
Typical recovery is about a week.
Usually, our patients tend to heal very quickly again avoiding general anesthesia and doing
this in local LITE sedation.
The whole quick recovery and natural appearance is something we get to help our patients benefit
from everyday.
So with that, I think that you should move forward and just do investigations.
Meet with doctors in person.
I can't stress enough the importance of safety factors of eyelid surgery.
This is a very delicate area.
Make sure the doctor you meet is highly experienced and is able to handle the first and second
and third level problems that can occur with eyelid surgery.
And once you find a doctor that you resonate with, move forward.
I think that you'll be happy that you did.
So I hope that was helpful, I wish you the best of luck and thank you for your question!