What should be done for the lower bags and darkness?
Relocation, removal and fat transfer?
I've really tried to do my homework on the procedures and all it has done is confuse
me and scare me.
I've seen 3 surgeons that have good reviews and they all said I should do different things.
According to what I have read off of this website I should do what is best for best
for my face anatomy.
Looking at my photos should I do fat transfer with removal of fat pads or should I do fat
relocating?
And why?
Which one will have the best results?
Please help!!
Thank you for your question!
As stated in your question, you’ve really done your homework and you met with 3 surgeons
and you’re trying to look for the perfect solution for the bags under your eyes.
And naturally, to your surprise there’s inconsistency in the opinions of doctors in
terms of what to do.
So to summarize, you’re asking about removal, relocation as well as fat transfer.
So, your confusion is certainly understandable, and when we look at patients, we look at anatomy
of course and in the context of their facial aging.
I wrote a book a few years ago called “The Fine Art of Looking Younger” and I’ve
been in practice for 20 years and a specialist in oculofacial plastic surgeon.
I do a lot of eyelids and I do a lot of facelifts.
And facial aging is something that I spend a lot of time and focusing on and helping
people understand the elements of the facial aging process and how well a given particular
plan impacts on that.
So let’s just define a couple of things that are issues here.
One is of course lower eyelid fat prolapse and with your photos, you clearly demonstrate
that.
But I also point out to my patients who come in for eyelid consultation is to also look
at the adjacent area, the area called the eyelid-cheek junction as well as the area
of the cheek or the submalar area.
When you have bags under your eyes, it is often the dominant feature and it is what
really detracts from the overall appearance of your face.
When people have this type of procedure done and whatever surgery they have done and the
fat pockets have been properly addressed then they look at the rest of the face and sometimes
they think that the look hollow or they look sad.
And why?
Because the adjacent areas of the face have also aged and because they weren’t dominant,
the focus was not there.
Now in terms of distinguishing procedures, as a specialist, I can tell you that in my
experience, fat transfer to the lower eyelids is not advisable.
I see patients from all over the world who have had fat transfer and they end up with
irregularities and lumps and it just doesn’t work.
The theory or concept is to try to build up and restore the fat that’s been lost and
then try to camouflage the fat pockets.
Well, there are several defects in that idea.
What the problem is, is that the fat that is under the eye has prolapsed forward so
it’s like a hernia.
Therefore, as herniated fat, it has to be addressed in some way to restore it in its
proper position.
MRI studies have shown that people with fat prolapse actually have more fat.
In other words, they have an enlargement or an increase of fat.
Thus, it’s justifiable to do procedures where you actually reduce or remove the fat.
As far as the transposition or relocation is concerned, this is an area that is very
often sounds much better than it actually is in practice.
Moving fat from the orbit or the space where it is and moving it in the adjacent areas,
may make sense but a lot of people who get fat transposition will actually not have a
good result and will actually have chronic swelling in the area where it is moved into
the eyelid-cheek junction.
So although in my practice, I do some fat transposition, the majority of patients like
you who have all this extra fat, I actually do fat reduction because it is logical to
reduce fat that is herniated past the rim and to get that type of contour.
Concerns about hollowing and things like that are always addressed, and that is where I
think is your confusion, is at why would three different doctors give you three different
opinions.
Because cosmetic surgery is an art, and it’s not a commodity and isn’t duplicated equally
between doctors.
Every doctor comes to the table with their aesthetic sense, with their experience, with
their technical abilities, and of course, with the procedures that best work for them.
And there’s a lot of finesse with what we do.
That’s why you can’t just shop doctors like you shop for vacuum cleaners or televisions.
Commodities that are absolute, you can certainly look for the lowest price and get what you
want.
But when it comes to medical care and surgical care, it is really more of a gestalt of how
you feel in terms of your comfort level with the doctor, with the style, and that’s usually
demonstrated by looking at before and after results, and then getting a sense of the aesthetics
and being in synergy with that.
At the end it’s always trust and being comfortable.
So, in helping you make at least one distinction, I would advise against the fat transfer.
As far as resection versus transposition, I think a lot of very good surgeons do a combination
depending on what they see.
It’s similar to what we do in face lifting surgery.
When you look at doctors promoting face lifting surgery, very often, certain doctors will
claim they only deep plain.
You know that’s really absurd, because if the person isn’t a good candidate for deep
plain, they’re going to do something else.
So they may just say that, but they really are doing whatever is appropriate for the
patient.
Cosmetic surgery is still ideally about customization.
Some doctors like to do things a certain way and they’ll always do it the same way.
Very often, those are the doctors that get themselves in trouble, because a certain percentage
of patients don’t have an anticipated or ideal outcome because they used a cookie cutter
approach.
So I think that meeting with doctors who have a lot of experience with eyelid surgery, particularly
as a specialty, will probably help you make that decision.
But understanding what to anticipate, I think that unfortunately at this point here, you
are someone who has a little bit of information overload, and unfortunately that results in
paralysis of analysis for many people, you just don’t know what to do.
So, understanding that it is a very individual result performed by individual doctors and
it’s your decision to find the doctor that resonates with you and then see through the
procedure, ultimately will probably be the most beneficial solution for you.
So, with that being said, I hope that was helpful and wish you the best of luck.
Thank you for your question.