Thank you for your question.
You're 18 years old.
You submitted several photos with your eyes looking up.
And you're concerned about the puffiness under the eyes and the discoloration under the eyes.
And you want to know what to do.
Well I can certainly give you some guidance.
I'm a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
And I specialize in under eye bags, it’s one of the most common things we deal with
in our practice.
So I can tell you how we would approach – or I would approach someone like yourself in
our practice.
So to begin with, at 18, clearly this is a genetic issue.
There is puffiness under the eyes.
So what is causing the puffiness?
The puffiness is caused by something called lower eyelid fat prolapse.
Lower eyelid fat prolapse means that the fat that’s normally around the eye pushes forward.
And in situations like yours, it’s clearly a genetic trait.
Now it may not mean that either of your parents have it but it definitely runs in the family
somewhere.
On top of that, the skin color can also be an issue and again I would say that the skin
color is more likely to be a genetic issue as opposed to someone who has spent a lot
of time in the sun and has what’s called photo aging and discolorations from that.
So the challenge before us is what to do about this situation?
Well, in the absence of a three-dimensional evaluation or examination, for you, you have
essentially a couple of options.
If the puffiness is not that prominent – you know when the photos – photos you can show
and you can see something look even – is more exaggerated because by the nature of
photography than what – how it looks in person.
So I would say in our practice, if someone has a slight degree of puffiness and they’re
young, we’ll consider a non-surgical option such as a filler, such as Restylane into the
tear trough area to fill that groove that essentially is an interface between the puffy
bag and the rest of the bone structure.
In addition to the Restylane, we use something called platelet-rich plasma.
Platelet-rich plasma is derived from your own blood and when the way we do it and the
way we apply it, we’ve been able to help a lot of people improve their dark circles.
It’s not going to eliminate but it seems to, even in genetic dark circles, have some
value in improving the skin quality and some of that pigmentation.
Pigmentation from dark circles can be anything from superficial to the melanin, which is
the pigment that gives us skin color, hair color; as well as the transparency of the
skin which is a function of natural color and thickness that results of being able to
see through to the muscles and to the veins under the skin.
So when we use platelet-rich plasma, we’re helping the skin quality gets slightly thicker.
And of course it’s something that we figure out based on a patient’s response, a schedule,
and when they should have it done again.
So that’s one option.
The other option is similar except that it would require addressing the fat pockets directly.
That’s a surgical procedure, it’s called transconjunctival blepharoplasty.
That’s a procedure where I go from the inside of the eyelid and I go directly to the fat
pocket that’s causing this bulge to occur and sculpt it and reduce it in a way so that
it does not push forward anymore.
It is still routine for me to use platelet-rich plasma as part of the treatment to improve
skin quality.
And it’s – as intimidating this surgery may seem, it oftentimes is actually a more
convenient and a less complicated process in terms of management beyond the actual procedure.
With fillers, you will always have to see people.
Like what we do in our practice, we see people at two weeks and then we add a little bit
if we need to add.
And it gives a certain amount of maintenance involved.
So it’s – definitely, there’s pros and cons to both.
And really, we want to do the thing it’s most appropriate for you.
A lot people to avoid surgery, get fillers which eventually gives them a ridiculously
pillowy look in a way that looks unnatural.
We have a patient of ours who I've been using hyaluronidase on her for multiple times because
she had this volume in her face that made her kind of look like a chipmunk.
And it took a lot of enzyme removal, a lot of sessions to get her to the point where
she actually recognized herself.
So it’s always – she is something – a patient like that will also reminds me of
understanding the appropriateness and the strategy to get the best possible result.
So I think at this point you should meet with experienced qualified cosmetic surgeons who
do a lot of eyelids, who are comfortable with treating someone young like yourself.
And think about these other collateral beneficial modalities such as platelet-rich plasma to
help improve your skin quality concurrently with addressing the under eye bags.
So I hope that was helpful.
I wish you the best of luck.
And thank you for your question.