Thank you for your question.
You're 26 years old and you're stating that your upper eyelids are puffy and that your
lower eyelids look hollow and that you've tried creams without any success and certainly
you're trying to get some guidance as to what to do.
Well I can certainly assist you with this question with a photo you submitted.
I'm a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years.
As far as the oculoplastic training is concerned, my background training before plastic surgery
of the eyes was in eye surgery.
So this training further was in advanced cosmetic and reconstructive surgery of the eyes and
eyelid surgery is a very big part of what I do and helping people like yourself is what
my practice is all about.
So to begin with, let's start by first focusing in on the under eye area and the hollowness
you're describing.
What I notice in your photo is there is hollowness, but just above that there's puffiness.
So I think that, without the benefit of a physical examination, I think we can reasonably
conclude that the puffiness is what's making the hollowness look deeper.
I always explain to my patients that when they're concerned about hollowness, they look
at the negative space and they don't realize that there is a mountain next to the valley.
So the mountain, or the puffiness under your eyes is what's making the valley, or the hollowness,
look deeper.
Now there are a lot of reasons for this, but looking first at the puffiness, we have to
have an understanding as to why those under eye creams didn't help.
And when you bought those under eye creams, a lot of them stated that they can help under
eye puffiness.
Well, the under eye puffiness is caused by something called lower eyelid fat prolapse.
Lower eyelid fat prolapse means that the fat that's normally around your eyes has pushed
forward, creating a bulge, and that bulge has pushed forward and is creating this look
of puffiness and always looking tired.
Now you may ask yourself why at 26, which is relatively young, you have this.
Well, most of the time this is a genetic trait, so you may want to look in your family tree
on both sides of your family to see who else has this issue.
Anecdotally, I've operated on members of three generations in the same family because of
this very strong genetic characteristic.
The youngest patient we ever operated on was 14 years old, so you can understand that it
can happen that young.
In fact, many of our patients who are in their late twenties and early thirties will recount
that they’ve had this problem since they were in their teens.
So, that being said, what my approach to someone like yourself would be is to do something
called a lower eyelid transconjunctival blepharoplasty.
Now that mouth full of words means that what we're doing is we're approaching the fat pads
from the inside of the eyelids.
When you think about lower eyelid surgery, there's an external approach called transcutaneous,
and then an internal approach called transconjunctival.
Well since you're not likely to have extra skin, we can do this from the internal aspect
of the eye, this way you avoid an external scar and we’re able to approach the fat
pads and sculpt them appropriately.
This type of procedure has tremendous satisfaction amongst our patients.
Getting rid of the bags under the eyes can literally be like a facelift, it really just
brightens up the whole face.
The procedure in our practice is done routinely under local anesthesia with light intravenous
sedation.
It's performed in our office, in our Joint Commission-certified facilities, which are
basically hospital-level facilities in terms of safety and sterility, but performed in
the convenience of our own office.
Local anesthesia with light sedation also allows us to avoid general anesthesia.
Now this may be a big part of the solution but you may benefit from other complementary
type of procedures such as the use of platelet-rich plasma and other ways to help improve skin
quality.
In terms of facial volume and hollowness, that may be more of a genetic issue but there
are solutions for that, but it just depends on how aggressive you want to be.
Again I would state that for many of your contemporaries who come to us as patients,
I try to minimize how many things we do for them.
Usually taking away the big negative is adequate.
Now for any reason this does not appear to be a family trait, there are other medical
issues that might be a factor, you might want to see an ophthalmologist or a medical eye
physician to just make sure that there is no other signs of other thyroid-related issues,
or have a medical doctor just make sure that there's no other complicating factors.
People will often also concurrently have sinus problems and allergies—that’s not a hundred
percent responsible for the fat prolapse but certainly can contribute to the puffy appearance.
So I would recommend that you meet with qualified and experienced cosmetic surgeons, learn about
your options, get comfortable with the way the procedure is done, look at before and
after pictures that that particular surgeon has performed, and once you come through with
the doctor I think that moving forward, you will at least unburden yourself of this dominant
feature in the lower eyelid.
So I hope that was helpful and I wish you the best of luck.
Thank you for your question.