Thank you for your question. You’re 41-years-old and you describe a scenario where 2 months
prior, you underwent some platelet-rich plasma (PRP) injections around the eyes you referred
to as Vampire facelift but without the hyaluronic acid filler. You had some Botox™, you had
some bruises and swelling and you state that you had under eye bags since that time. And
that you’ve been advised to undergo transconjunctival blepharoplasty but you are looking for a gentle
approach in dealing with the bags and it appears that you may feel that the there was a cause
and effect here.
Well, I can certainly give you some guidance. I’m a board certified cosmetic surgeon and
fellowship trained oculofacial plastic and reconstructive surgeon. My background training
for eyes was first ophthalmology and then advanced training of plastic surgery of the
eyes which is called oculofacial plastic or oculofacial plastic surgery. I’ve been in
practice for over 20 years. I am also a member of the Vampire Facelift network of physicians
and I have been a resource for the media at a time for commentary about the Vampire Facelift
procedure.
I use platelet-rich plasma (PRP) a lot in my practice. We use it for many indications
from under eye dark circles, from fine lines and wrinkles to acne scars as well as in combination
with Acellular matrix and other elements for non-surgical hair loss. I perform pretty much
every day in my practice and I am an expert in helping people with problems such as under
eye bags as well as its complications of eyelid surgery. So it is interesting to hear about
your experience. I think that without the benefit of photos, I’ll give you some understanding
about the anatomy of the issues involved.
So to begin with, platelet-rich plasma (PRP) is a concentration of the cells and the growth
factors needed or healing factors needed when there is wound healing. And so by using platelet-rich
plasma (PRP) in the skin, you are able to improve skin texture and quality. Having a
bruise or swelling is a byproduct of just entering the skin with a needle as well as
just usually a little bit of fluid from the actual volume of platelet-rich plasma (PRP).
Sometimes there can be a little bit of swelling response to the stem cells or adult stem cell’s
activity and wound healing process which is basis for stimulation for collagen. Now anatomically
speaking, eye bags are manifestation of lower eyelid fat prolapse. That means the fat that
is behind the septum or barrier that is behind the skin and the muscle is actually the barrier
that prevents the fat from moving forward. And anatomically speaking, there are basically
two issues with lower eyelid fat prolapse: one is genetic thinning of the septum as well
as increased volume of lower eyelid fat.
It may be that you were dealing with some degree of this lower eyelid fat prolapse where
there were some good days and bad days. That’s from my own experience with patients who I’ve
been performing this surgery for over 20 plus years. At a certain point, there is a threshold
that is reached where the fat just pushes forward and you can’t do anything about
it. Sometimes with medical treatment, there is a correlation causation type of logical
fallacy where the event can occur and then you see this fat pocket and then you think
that there is going to be a cause and effect. But with platelet-rich plasma (PRP), simply
there is no basis to actually see a connection which can anatomically cause fat to prolapse
forward. That being said, I think that who someone recommended transconjunctival blepharoplasty,
that doctor must have observed there is significant fat prolapse.
Now, when you are asking a gentler approach which I can tell you in our practice, when
I do transconjunctival blepharoplasty, again something I do pretty much every day of the
week, we have developed a gentler approach overall which is done under local anesthesia
with LITE™ sedation and it’s not that different from undergoing a filler. It is
still surgery so we don’t want to understate that but in our practice, we have our own
facilities in the office. And I have observations that many times, patients have almost no bruising
at one week and one can argue that you can have actually less bruising from a transconjunctival
blepharoplasty than you would with injectable filler.
So the idea of surgery maybe a little bit daunting to you but understand that this scenario
can also exist where it is almost getting an injectable filler. We sometimes even combine
injectable fillers with these procedures. So, I think you can get some peace of mind
that’s not likely platelet-rich plasma (PRP) that caused the lower eyelid fat prolapse
to occur. You can allow several months to transpire to see degree of persistence of
this fat prolapse and get additional opinions so that you can be secure in the diagnosis
and then find the right the doctor to perform the more definitive procedure for you.
We do use platelet-rich plasma (PRP) in combination with transconjunctival lower eyelid blepharoplasty
routinely. In fact, for lighter skin patients, it is typical for us to do transconjunctival
blepharoplasty, platelet-rich plasma (PRP) and lower eyelid fractional CO2 laser or Erbium
laser so it is a great combination to help rejuvenate the under eye area.
So I hope that was helpful, I wish you the best of luck and thank you for your question!