Thank you for your question.
You've submitted several photos and you state in your question that you've had these bags
under your eyes since you were 15.
You're now 50 and you wanted to do the procedure with minimal invasiveness and minimal cost.
And you wanted to get some guidance on how to achieve the most natural look.
Well I can certainly give you some guidance and how we do what we do in our practice.
I’m a board certified cosmetic surgeon certified by the American Board of Cosmetic Surgery
and a fellowship trained oculofacial plastic and reconstructive surgeon through the American
Society of Ophthalmic Plastic and Reconstructive Surgery.
And I've been in practice for over 20 years in Manhattan and then Long Island.
Under eye bags is one of the most common issues we deal with.
And thanks to unfortunately a lot of celebrities with undesirable looks from the – from the
opinions of most people, as well as a lot of observations of very plastic-looking people
walking around the malls and streets of New York that people are really focusing on the
word natural.
And I think that as the cosmetic field becomes more and more accessible; and the knowledge
and the information becomes more accessible, so too the – are the unfortunate negative
associations with cosmetic surgery which, of course, make people want to avoid any type
of procedure that makes them look less natural.
So let’s define what natural means.
And I’ll tell you how we would approach someone like yourself.
When I talk to patients about looking natural, especially with under eye bags, I tell them
that, essentially, you want to look as if you never have the bags.
You know with the – bags under eyes make someone look so much older, so much tired
– so tired; and no matter what age you're at.
And this is – we have operated people as young as 14 or at least in their 20s.
And as old as in their – in the later decades, 80s and 90s.
So clearly, that’s – there is always an age-related association.
But more of this is a genetic issue.
So that’s – and the puffiness is something called lower eyelid fat prolapse.
That means the fat that’s normally around the eyes pushes forward, creates this bulge.
It’s often referred to as herniated fat.
Now when – in order to achieve a natural look, what – are some of the things we want
to retain and what are the things we want to avoid.
Well, we want to retain the true shape of the eyes.
You know one of the things that happens after people have cosmetic eyelid surgery, particular
lower eyelid surgery, is from what I've seen other people do with is to get a lot of rounding
of the eyes.
The lower eyelids get pulled down and they become retracted.
And in fact people come to us from all over the world for repair of lower eyelid retraction.
We have had patients from almost every continent who have come here because their eyelids were
pulled down or they just ended up with a shape they didn’t like.
That rounded shape may look like something some people like.
But for most people, the character of the eye shape is something that goes together
with the character of their face and their personality.
And when that shape is taken away, it’s very – it’s very distressing.
Now that being said, what I do typically is I work from the inside of the eyelid and I
preserve the muscles necessary to retain that shape.
And so it’s called the transconjunctival blepharoplasty.
In many ways, that can be considered minimally invasive.
Now the other side of this equation is of course skin.
Is there extra skin?
Usually, there is not.
But is there opportunity to help with skin quality?
Usually there is.
And skin quality is something we’ve become very good at helping people with – of all
skin types.
But routinely for people with lighter skin, I would do a combination of a laser procedure
such as a fractional CO2 laser and use something called platelet-rich plasma; which is derived
from your own blood.
It contains the growth factors and the healing factors that stimulate skin quality.
That’s been very successful for us in our practice.
So you combine these three modalities, address the fat pockets from the inside; minimally
invasive.
And address the skin quality by using laser and platelet-rich plasma and you've got a
very nice impact on your overall appearance.
And the fascinating thing is people are not going to usually notice.
What they’ll say is “You look really good.
You look like you’ve changed your hair."
You know, “It looks very natural.”
And to me that’s the definition of natural.
I’ve written a book about this and I'm constantly speaking when I lecture in both professional
meetings and to consumers or patients about this.
And is really is – there’s a certain style and that’s very important.
I also stressed that there has to be an artistry.
You know nature and the way we look at people, there’s a certain ratios and certain balance
that’s so important.
And when it looks natural, it’s almost you can’t perceive it.
But when it looks obvious, that’s when you look at someone and say, “Hey, you have
a nice – you had surgery.”
And that’s not what you want.
So with that being said, as far as cost is concerned, understand that cost has to be
based on value.
You want quality.
You do not want to save money when it comes to risk – a high risk procedure in terms
of your health and your eyes.
So you want to get value.
So in our practice to address that cost concern, we have our own facilities.
We have a – they’re all certified by The Joint Commission.
We have operating rooms in both offices.
And we’re able to address some of those concerns.
But we – but we never, you know, cut corners.
There’s the surgeon’s fee, anesthesia, and facility.
And it’s very important that to maintain quality, you do invest what is – are the
best value for you.
But don’t just always use cost as your guideline because you've – you – it’s really unheard
of getting something very cheap and getting something really great when it comes to medical
services.
It just doesn’t work that way.
So I hope that was helpful.
I wish you the best of luck.
And thank you for your question.