can I have puffy eyes and hollowness at the same time we see a lot of people in
our office concerned about puffy eye bags and hollow under eyes while they
may appear to be opposite situations there are certain circumstances where
they can exist concurrently I'll discuss how I assess patients with concerns like
these in the eye area and how I develop treatment solutions for them
I'm Dr. Amiya Prasad I'm a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon I've been in
practice in Manhattan and Long Island for over 20 years as a cosmetic
oculofacial I specialized in primary upper and lower eyelid cosmetic surgery
non-surgical eyelid treatments including the application of injectable fillers
neuromodulators and lasers as well as the correcting of complications of
eyelid surgery originally performed by other doctors helping people with puffy
eye bags is something I do every day along with treating hollow eyes and
discoloration of the lower eyelids a common concern for patients who come to
me after having their under eye bags addressed elsewhere is a perception of
lacking volume under their eyes often refer to as appearing hollow
paradoxically we often see patients who have had treatment for hollowness by
another doctor and come to see me because they find themselves with IBEX
there are several different conditions where you can have both puffy eye bags
and hollowness present simultaneously the most common of which is when the
elevation of under-eye bags make the lower eyelid look relatively hollow this
is like a mountain next to a valley in such cases people often only notice
hollowness not realizing it's the eye bags that are making their eyes look
relatively hollow in these cases reduction and sculpting of the fat that
causes the eye bags can have a significant improvement in the patient's
perception of a hollow look when I treat under eye bags
surgically I sculpt a fat to create a natural look with the goal of having you
look like you never had eye bags I performed his type of lower eyelid
surgery using a method called transconjunctival blepharoplasty as
opposed to the more common transcutaneous blepharoplasty during
transconjunctival blepharoplasty the fat pockets responsible for the eye bags are
assessed from behind the eyelid so no external or outside incisions are made
in the lower eyelid from the way I perform this technique my patients are
able to see themselves afterwards with the more natural appearance like they
never had eye bags I also am able to avoid common complications associated
with an external incision it's often seen in people who have undergone the
outside incision or transcutaneous method to access the fat pockets to find
that delicate lower eyelid support structures are compromised and the
eyelids become pulled down leading to a rounded look many doctors often combine
the transcutaneous method with skin removal to try to treat wrinkles which
only contributes to more rounding due to the eyelid skin being a deficit or
shortage in my practice when my patients want to improve the appearance of
wrinkles under the eyes I generally don't remove skin but rather I improve
the eyelid skin quality with non-surgical treatments I use
platelet-rich plasma or PRP to thicken the skin improve texture and stimulate
collagen as well as using laser treatment to
prove the superficial and deeper layers of the skin there are times when the fat
pockets are so large that the underlying hollowness in the tear trough and cheek
are hidden although some doctors advocate procedures such as fat
transposition into the tear trough I generally feel these procedures to be
imprecise and minimally predictable I counsel my patients to understand that
after the under eye bags are addressed volume enhancement of the tear trough
and cheek can be performed safely and predictably with hyaluronic acid fillers
another scenario is when there is significantly puffy eye bags and at the
same time there is a lack of cheek bone projection this is typically seen with
facial aging as we age there is a progressive loss of bone muscle and fat
in the face for volume correction on the cheekbones I approach this area a
little differently than most doctors I use a technique called Structural
Volumizing where the filler is placed at the bone level below the muscle layer
when placed in the space the filler is much more stable and provides the cheeks
with solid structure and definition creating a natural youthful appearance I
use longer-lasting fillers such as Juvederm Ultra Plus or Juvederm Voluma
it's common with more traditional filler methods to place filler in the cheeks
right under the skin for the filler to migrate and look soft and doughy when
treating puffiness under the eyes as well as hollowing it's important to also
look at the whole face I often tell my patients that the whole is greater than
the sum of its parts addressing puffiness and addressing
areas of relative hollowness gives the face a more balanced refreshed and
youthful appearance I hope you found this information helpful thank you for
your question
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