Thank you for the question.
You’re 20-years-old and you submitted several photos and you have described some concerns
about under eye bags.
You also express concerns about the potential of hollowing and you’re considering since
you have done some research lower lid blepharoplasty, fat grafting fillers.
You don’t like the idea of maintenance fillers and of course you are concerned about the
appearance as you face ages.
Well, I can certainly give you some guidance on how I help patients like yourself who come
into my practice.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years and under
eye bags is something we pretty much do in our practice.
So, I can give you some guidance but first we should discuss a little bit about what
the anatomy anatomical issue is.
So what you have is basically is lower eyelid fat prolapse which means that the fat that
is normally around the eye is pushed forward and I think you probably essentially figured
that out from your research so the question is: what to do?
Do you take away the fat?
Do you transpose the fat?
Well certainly, even with the factoring in of aging, I would say that the majority of
patients who like yourself who I treat, I do a combination where I reduce fat and is
done from the inside that is called transconjunctival blepharoplasty.
That means there is no incision from the outside and the approach is done from the inside and
any fat that is pushed forward, it is reduced.
Now there are ways to transpose the fat and to move it in places where it may appear to
be hollowed but at 20, I just don’t think it will be necessary.
Now of course you are now anticipating what will happen as your face ages.
Well, I think that even people who are much older where I have done exactly the same procedure
for women on their 70’s and it has been appropriate so I don’t you have to necessarily
be worried that you are going to look unnatural as you get older.
You’re basically dealing with an anatomic issue where fat is not where it belongs.
I agree with you that fillers would not be of value not because of the concern about
maintenance but because the fat pockets are just pushed forward to prominently.
In our practice, we help who have mild degrees of fat prolapse with the use of Restylane
and to help skin quality with platelet-rich plasma (PRP).
But in your case, that’s not going to be appropriate.
But once a fat pocket is too pronounced, there is no reason to do anything else.
I think that what you have to do is to wrap around your mind the idea that the appearance
of your eyes without the fat pockets after surgery should be as if you never had the
fat pockets there to begin with as if you would have that look without the fat pockets.
Now if you are conflicted and not sure what to do, wait until you are comfortable.
Meet with qualified and experienced cosmetic surgeons who perform both surgical and non-surgical
procedures and learn about you options.
This is an important decision.
Certainly I have done this procedure for young people and as young as 14 because of the genetics
and not related to aging and it’s basically genetic trait.
And patients who I treat in their 20’s, 30’s and 40’s will frequently tell me
that they had the bags under the eyes either they are born with them or they hand since
they are teenagers.
So you certainly have to make some decisions based on the risks and benefits and once you
understand that there is no ideal procedure.
But I would say that transconjunctival blepharoplasty, for over 20 years of helping hundreds of patients,
that you really can hit a homerun when it comes to helping people look their best.
I would say that helping people with bags in their eyes is literally doing a facelift
and it really makes such an improvement on the overall facial appearance and the most
common thing I hear who are a lot older than you they say if I knew it was this easy, I
would have done it sooner.
So in your situation, I think that you need to meet with doctors and consider your options
but it’s fairly straight forward from my perspective.
So I hope that was helpful, I wish you the best of luck and thank you for your question!