Crepey skin under eyes with bags, can this be fixed without Blepharoplasty?
I am 30 years old, but my eyes look 50+. When I do not smile, my eyes look puffy underneath,
as if I have a sinus infection but I do not. When I do smile, the skin underneath my eyes
becomes crepey. I look like a Sharpei. I feel like I am too young to get a blepharoplasty.
However, if that is the real solution I will get it. I just don't want to spend lots of
money on different fillers/lasers and what not only to find out that I really should've
just gotten the bleph to begin with. Any advice?
Thank you for your question!
You stated in your question that your 30 years old but your eyes look like you’re over
50. And you described in very nice detail the presence of puffiness when you’re not
smiling, presence of wrinkled skin and crepey comparable to a Sharpei when you’re smiling
and you’re asking can this area be improved without surgery and so it’s certainly a
reasonable position to be in that you feel like at the age of 30 that the eyes are looking
disproportionately looking aged compared to your chronological age.
So I’m going to share with you our approach in our practice when we meet people like yourself.
As a cosmetic oculofacial plastic surgeon specializing in cosmetic surgery of the eyes
for over 20 years in Manhattan and Long Island, I have dealt with the whole spectrum of situations
and ages that I can give you a lot of perspective to help you make an intelligent decision.
So with that being said, when someone like yourself comes to us, we first start with
the history. We have to ask ourselves what are the factors that are causing the eyes
to look disproportionately older than your age. A lot of times, there are two factors
that probably dominate the history that accelerates aging: One is smoking. People who smoke do
tremendous amount of harm to not only their physical body, their organs, their hearts,
lungs but in addition, they accelerate the aging of the skin. The eyelid skin is the
thinnest skin of the body and it is subject to stress. It’s very sensitive to stress
and imagine with smoking, the carbon monoxide which starves the cells with oxygen and combine
with generation of free radicals, it is really damaging to the skin.
The second part is sun exposure. Sun exposure causes something called photo aging. It accelerates
the aging process and several studies have been done comparing people who leave in the
East Coast and the West Coast and these certain studies involve twins. Even when the West
Coast individual is very good about sunblock and being smart about avoiding excess sun
exposure, incidental sun exposure always makes them look a lot older than their East Coast
counterpart. So those are the environmental factors that you have to think about. If you’re
a sun worshipper and you go to tanning salons, you need to stop that or reduce that. If you’re
a smoker, you need to stop altogether. There’s not doctor in the world who’ll say continue
smoking. A lot of times you need to cut it down or switch some type of a alternative
such as nicotine patch or gum or even something like a drug like Chantix.
But then we look at also ethnic background. It is well established that people with what’s
called Fitzpatrick type 1 skin, this is typically light skin, Irish person. So with light hair,
blue eyes and light skin will photo age or skin will age faster than Fitzpatrick type
5, someone who is African skin who has thicker skin and pigment. So, this could be a combination
in the same line as ethnicity as genetics. Does this trait appear to run in your family?
So once we’ve established that, it’s definitely important to not label a particular time that’s
always right to do cosmetic surgical procedure. It’s not really about timing but it’s
when you have a particular issue that needs to be addressed. So at the age of 30, I can
tell you we have done blepharoplasty, lower eyelid surgery on people considerably younger
than you. We have had many patients who are in their 20s and the youngest patient we have
treated for lower eyelid bags or under eye bags was 14 years old. This was a young man
who was being teased at school because everyone was saying he was on drugs. And so, again
it’s more when you have a problem that you do something about it rather than waiting
for a particular age milestone.
So in our situation, we would address two issues: one is the puffiness. Now the puffiness
under your eyes is caused by lower eyelid fat prolapse. Lower eyelid fat prolapse means
that the fat that’s normally around your eyes, pushes forward, creates a bulge and
makes your eyes look puffy. When you smile, you activate a muscle called the orbicularis
muscle and it has a tendency to push those fat pockets back. So certainly, they may not
be significant when you’re smiling but unless you’re smiling all day long continuously,
when people see you, they will see the puffy under eye bags and wonder why you’re so
tired. With someone who’s relatively young like yourself, we typically do a procedure
called transconjunctival blepharoplasty. Transconjunctival blepharoplasty is a method of approaching
the fat pockets and resecting, repositioning, whatever is necessary from the inside of the
eyelid this way you avoid an external scar.
That being addressed, we also address the quality of the skin. What makes the skin quality
challenging? Well it’s the thinness. It’s the crepiness, it is half a millimeter thickness.
So we do a dual approach to the improvement of skin quality. One is we use a thermal device
called fractional cO2 laser. Fractional cO2 laser is essentially using fractionated laser
energy which means this is done in several dots with small spaces in between to generate
finely placed thermal energy to resurface to a degree the external skin as well as to
deliver energy to the dermis or the backbone of the skin to cause to contraction.
In addition, we use something called platelet-rich plasma. This is derived from your own blood
and it has been a remarkable benefit in synergy with co2 laser. What this does is it generates
collagen based on a wound healing model where you get a cut, your body generates collagen
to fix that area and to create new skin or repair skin. So the idea is with platelet-rich
plasma, we’re getting a stem cell based response that helps the quality of the skin
and color and we get really nice results. In patients who don’t have bags, we actually
combine it with a filler to even treat tear troughs or hollows.
So the combination of transconjunctival blepharoplasty, fractional CO2 laser and PRP is very much
routine for us and we’ve had very nice results this way. I think it’s important to do surgical
procedures when they are indicated. A lot of times, people are afraid of doing surgery
and they may have a concern that they are too young or they’re just afraid of surgery.
And the reality is that in our practice, the way we do things, we have our own facilities
within our offices. We are Joint Commission approved facilities, same people who certify
hospitals. What we’ve done, for our patients, we made this process as easy as it can be
and maintain the high standards.
What we’ve done in our office is create a facility where we maintain the high standards
set by the Joint Commission, the organization that certifies hospitals and surgery centers.
At the same time, in an office setting, it’s much more personalized and the people you
see are the ones you know. It’s less impersonal than a hospital surgery type of environment.
Plus we do our procedures under local anesthesia with LITE™ sedation. There are many times
that people have said that they’ve had less swelling and bruising a week after lower eyelid
surgery than they’ve had getting injectables. And there are certainly a lot of truth in
that because of the process that we’ve developed over the years and we’ve been able to get
people looking good pretty fast.
From my perspective, you really do have something that requires a more definitive procedure.
It doesn’t mean that we want to negate other things such as topicals like retinols and
other skin maintenance procedures but I would avoid non-surgical solutions because I just
don’t think they will be adequate to address your concerns. So I would advise that you
meet with qualified experienced cosmetic surgeons who perform a lot of lower eyelid surgery
and get a sense of whether or not you’re comfortable with them and move forward with
a more definitive plan.
The benefits of lower eyelid surgery is quite long lasting. Again, I’ve been practicing
for over 20 years and I’ve been very impressed with how good patients look for so long. Their
bags don’t come back necessarily and their eyes hold up very well. Again, it depends
on the age. If you do a procedure like this when you’re 30, it will hold up for many
years.
So I hope that was helpful, I wish you the best of luck and thank you for your question!