Thank you for your question.
You’re 30-years-old. You submitted a single photo and you feel like the under eye bags
and the darkness looks awful and that you are questioning is under eye bag surgery your
only option or can you do something like fillers, Botox® or laser.
Well, I can certainly give you guidance as to how I approach this issue with my patients
pretty much every day of my practice, all day long. 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 dealing with
under eye bags is something that we deal with all day long in our practice as I mentioned
earlier.
So it is an interesting time when it comes to addressing this type of issue and so to
before explaining what I would do, you first should at least have a sense of what the problem
basically is. So when you see someone whether they are younger or older who has puffiness
under the eyes that’s present regardless of salt intake, allergies, sinus problems,
well, that basically is an anatomic issue and that anatomic issue is referred to as
lower eyelid fat prolapse. Now when you are dealing with lower eyelid fat prolapse, it
basically means that fat that’s normally around the eyes pushes forward and creates
this bulge.
Now, in the past, the only definitive procedure was a surgical procedure. And so, a few years
ago, with the advent of softer hyaluronic acid fillers, there became additional strategies
such as ways to camouflage the presence of the under eye bags. So when I look at a patient
who has a certain amount of fat prolapse, the question I ask myself is first, is it
small enough that I could camouflage the under eye bag with the placement of a filler and
how does that work? Well, when you look at the puffiness under the eye, adjacent to it
is an area called the tear trough and that area is like a valley that’s next to a mountain.
So the option of using a filler is to try to fill that valley just enough so that you
can blend the area. Now the upside and benefit of this is of course it’s a limited procedure.
It is an injectable procedure. It is done in an office setting. It is, basically, you’re
in and out. You come in, half an hour later, it gets done and you’re going home and you
can buy yourself some time before you were to need a surgical procedure. The downside
also is that of course that because it is a procedure that works around the eyes, depending
on the technique, you can get some swelling, you can get some lumpiness; you can get some
bruising and so it’s almost like the part of a downside of even considering a surgery.
Now, when it comes to the surgical option which can be the most where you end up finally
is actually a fairly straightforward option but it is something you want to do when the
time is right. And so typically, for a 30-year-old like yourself and without a physical exam
but basically as a general rule of thumb, I would do a procedure called the lower eyelid
transconjunctival blepharoplasty. Transconjunctival blepharoplasty means that I’m basically
approaching the fat pockets which have pushed forward which is the underlying problem and
I sculpt those fat pockets to help them blend and not bulge out and create this area of
puffiness. Now that is done under local anesthesia with LITE™ sedation. So the only difference
is that there is a little bit of sedation. It is done in our office operating facility
but what is nice is you’re not placed under general anesthesia. So when you try to come
up with the real distinction between surgical procedure versus an injectable procedure,
the differences become less significant when it is done in this approach. And I did this
intentionally so that our patients would feel comfortable. We do our procedures in our Joint
Commission certified facilities in our office so essentially instead of going to an exam
room, they go into our operating suite and before you know it, the procedure is done.
Now one more element that I do use whether it is with the injectable filler or with surgery
is that for the dark circles or the quality of the skin, we will often do something called
platelet-rich plasma (PRP). Platelet-rich plasma (PRP) is derived from your own blood
and it is a concentration of the wound healing and growth factors in your blood that does
help with improving the skin quality including the appearance of discoloration as well as
fine lines and wrinkles.
So again, there is certainly an art to approaching this problem and what I would suggest is you
meet with doctors who do both procedures. A lot of times people, come to us and they
come to us from all over the world with well-meaning doctors overfilling the under eye area with
filler to the point where it makes their bags look much worse or having filler done at a
certain period timeframe and then the appearance of what’s called the Tyndall effect or bluish
hue that they don’t understand why it is still there, even though they had the filler
a long time ago. So there is still an art in doing this and there is an art to whether
or not you do the filler or whether you do the surgery but I think that when you go to
a doctor who can do both, then you actually get more likely a fair, unbiased opinion.
A lot of times, very well meaning non-surgeons just want to place fillers when fillers may
not be the ideal option and I’ve seen that happen too many times to count. But nonetheless,
it is important that you be comfortable with the doctor who you are going to seek advice
from and look at their results and get a sense of what makes sense for you.
One of the nice things about even considering doing fillers first is at least you can see
what it looks like because if you are able to become comfortable with the fillers then
you might be in a good place then you may be able to buy some time before you do move
forward with surgery.
So again move forward with at least investigating this with qualified, experienced cosmetic
surgeons and who do a lot of work with eyes and see where you are comfortable. There is
also differentiation in the techniques whether direct injection or what I do with a lot of
my patients, I use something called blunt cannulas and use different techniques that
I’ve refined over years of doing this and try to make it minimally traumatic as possible
and looking as natural as possible.
So I hope that was helpful, I wish you the best of luck and thank you for your question.