Thank you for your question.
You submitted your question with some photos.
And you are describing in the details of your question that you are dealing with these under
eye puffy areas that are reddish in color and dark circles.
And that you have tried some remedies that were recommended in the internet and you met
with a doctor who said that the only solution is surgery and this is a hereditary problem.
And further, you are questioning why you don't see anybody in your immediate family with
these problems and can you find a solution without surgery.
Well, I can certainly help you with this question as I discuss this issue with my patients every
day in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And helping people with these under eye bags and discolorations both surgically and non-surgically
has been the core of my practice for several decades now.
So I can certainly help you understand a little bit about the question of genetics and heredity.
We always assume that we are products of just two parents but reality is that genes get
passed on through generations and sometimes one particular gene or set of genes is responsible
for essentially what this condition is.
And what is this condition?
This condition is something called lower eyelid fat prolapse.
Lower eyelid fat prolapse means that the fat that’s normally around the eyes pushes forward
and creates a hernia and that’s why it’s referred to as herniated fat.
The reason why these remedies did not work is that fat has a lot of volume.
And you are in good company.
A lot of my patients come in having gone to every department store and retailer and bought
all kinds of creams and ultimately found these not to be effective.
Further I would say, at this point, there are options in approaching patients who have
a little bit of lower eyelid fat prolapse.
And in the absence of a physical exam and other angles of the appearance of your eyes,
I basically break it down to you in two approaches that we apply for this particular problem.
The first approach which is often what people want is something that’s minimally invasive
because everyone is afraid of the word surgery.
And so, when someone has a mild amount of fat prolapse, it’s not a solution but rather
a camouflage approach and what we do is we use an under eye filler, a filler such as
Restylane, something in the hyaluronic acid family or Juvederm, and placing it at the
level in an area called the tear trough.
What that does is it blends the area of the prolapse with the area of the bone structure.
The limitation of this is the relative projection or prolapse of the fat.
So, if somebody has such prominent under eye bags and I suspect looking at your photos
that you may fall into this category then surgery is a treatment of choice.
In my practice, I routinely perform this procedure through an approach called a transconjunctival
blepharoplasty.
What this means is the fat pockets are approached from the inside of the eyelid and they’re
reduced and repositioned as is appropriate and it is a highly effective procedure.
Now for patients like yourself who want to avoid surgery, what we do in our practice
is we perform in our own facility within our practice and these facilities are essentially
equivalent to doing it in a hospital or surgery center as we are certified by the Joint Commission
and this is very important for a lot of patients of course because they want to maximize the
safety.
And further, the technique and approach is so minimal in a way, essentially, that going
into my office and either getting an injectable filler or going in and having a surgery, the
only difference is that you’re in the operating room and you get a little sedation.
The procedure is as minimally invasive as one can get and still address the problem
definitively.
It’s done from the inside of the eyelid.
There are no external scars and the anatomy of the eyelid is maintained.
Now to respond to the question about the redness and the dark circles, for your skin type,
we have had a lot of success in using something called platelet-rich plasma (PRP).
Platelet-rich plasma (PRP) is derived from your own blood and it is something that we
do routinely in combination with the surgery.
What we are basically doing is taking the wound healing and growth factors from your
blood and separating them and injected them under the skin as well as in the space where
the surgery is done.
We have found this to be a very useful thing to help our patients with these dark circle
issues.
And further beyond the surgery, it’s something that a lot of patients choose to do as a maintenance
thing to optimize the appearance of their skin.
It’s a choice you make depending on how things look and how important to you to manage
the dark circles.
So one approach is to deal with the fat pockets, the other is to deal with the skin.
And of course, there’s always different lasers and other things that are continuously
available and evolving to help us further improve the outcomes for our patients and
combining procedures is often a great strategy to get the best aesthetic result.
So meet with qualified, experienced cosmetic surgeons who do a lot of eyelid surgery.
Learn about your options.
Learn about platelet-rich plasma (PRP) and I think it is in our best interest to choose
the procedure that will give you the more definitive outcome in a way that you’re
comfortable rather than continuously chasing approaches like the home remedies or other
remedies that haven't been so effective.
So I hope that was helpful, I wish you the best of luck and thank you for your question.