Thank you for your question. You’re 27-years-old, you submitted a single
photo and you state in your question that the under eye bags and dark circles have been
getting considerably worse, that you have done everything to avoid excess sun exposure
and that your allergy testing has come back negative which you state this is a genetic
trait that you inherited from your father and you’re looking for options and for possible
solutions. Well, I can certainly give you some guidance
as to how I approach situations like yours in my practice. A little bit of background,
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
and treating the eye area and the cheek area for people like yourself especially younger
people can certainly be frustrating and it’s one of the most common issues we deal with
in our practice. So, I’m going to give you an approach that is based on how the systematic
thinking that goes behind dealing with the anatomy and then what to do about the anatomy.
So to begin with, we’ll start with what is the most straightforward and for to me
the most dominant issue for you and I think that is the puffiness. The puffiness certainly
further accentuates the significance of the dark circles. So it creates this perception
that you are very tired. That puffiness is an issue that is anatomic due to something
called lower eyelid fat prolapse. Lower eyelid fat prolapse means that the fat that is normally
around the eyes pushes forward, creates this bulge and maintains this continuous look of
looking tired. It is fascinating how this one thing can actually change the whole face
and people often say that everyone around them asks them are they tired, have they gotten
enough sleep and are they worried and things like that.
So to deal with the puffiness under your eyes, currently there are two solutions that are
generally offered depending on the doctor you go to. One is the solution of using injectable
fillers to try to camouflage the puffy under eye bags and the other is to do a surgical
procedure to reduce the fat pockets. Now, in my opinion with the photo you submitted,
I think that trying to camouflage the under eye bags would not be as successful and it
is because that when you look at the trough the tear trough area that’s right below
the under eye bags, it would take a lot of filler to fill that area to camouflage what’s
hanging over. Patients come to us from all over the world who have had injectable fillers
around the eyes and very often we have to dissolve them in order to actually see the
underlying anatomy. You see when someone gets too much filler under their eyes to hide an
under eye bag, it ends up making the baggy-looking area worse and it actually takes you two steps
backward.
I think that there is a certain degree of opportunity for you with fillers possibly
but I would say that the procedure that I would suggest is considering something called
a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is a procedure I do typically
for a younger person with under eye bags and what I do is I address the fat pockets from
behind the eyelid. This way there is no external incision, no external scars and it really
does address the issue directly. We are able to address the fat pockets by reducing it,
by repositioning it, by sculpting it appropriately so that you get a nice contour as if you never
had the bags.
Now moving onwards from there, and by the way the approach of doing this is through
local anesthetic with LITE™ sedation which means you don’t have to have general anesthesia
or go to a hospital. In our offices in Manhattan and Long Island, we have facilities for surgery
that are certified by the Joint Commission, the same people that certifies hospitals.
And so to me the appropriate protocols and safety standards while having the convenience
of an in-office facility has been a tremendous advantage for us and we do the surgery pretty
much every day in our practice.
Now that being said, let’s talk a little bit about the dark circles. There is one element
of the dark circles that has to do with genetic ethnic pigmentation. That is difficult to
really make a significant change in. However, I have found that when we deal with younger
people who have situations like yours, combination of approaches using something like platelet-rich
plasma (PRP) where it is injected under the skin to stimulate collagen and improve skin
quality, it has kind of a lightening effect on the under eye dark circles as well as improving
skin quality that tends to be beneficial. On top of that, we also do consider using
some topical creams as well as even some light microneedling or laser procedures but generally,
I try to avoid that when we are dealing with darker skin individuals. So we take it one
step at a time and I think platelet-rich plasma (PRP) injections will probably be most beneficial.
The reason I mentioned earlier that there may be a role for addressing this area with
some filler is that when you look at the bottom of where the bags are, there is this little
dip and we refer to this as the V deformity. There is a relative anatomic volume deficiency
there. Sometimes we get some benefit by adding volume with fillers such as Restylane or Juvederm.
Now fillers for someone who is young is often an obstacle and has to be really considered
thoroughly before having it done with consistency because fillers do require maintenance and
that is something that I would typically discuss with my patients after taking their photos
and showing them on our screen what they look like from different angles so they understand
what’s bone deficiency, what’s puffiness, what’s pigmentation. Really a proper consultation
is critically important to understand what the optimal plan would be for you.
So I recommend you to meet with qualified, experienced cosmetic surgeons and learn about
these options. Learn more about the option of transconjunctival blepharoplasty, platelet-rich
plasma (PRP) for skin quality and I think that you will find that you can really make
a nice improvement and still look like yourself look natural.
So I hope that was helpful, I wish you the best of luck and thank you for your question.