Tighten skin or bags under eyes?
The skin under my eyes is loose and it looks like I have small bags under my eyes. I need
a surgeon to help me maybe tighten the skin. Any suggestions on what kind of doctor I should
use? Plastic surgeon - but anything else I need to look for? I live in Beaverton, OR.
Thank you for your question!
You submitted two photos and you stated that you wanted to tighten the lose skin under
your eyes. And you've asked about what else you should look for in terms of the type of
doctor that you want to perform your surgery.
You've asked a question that certainly has some element of controversy. But I'll share
with you my perspective as a 20-year practicing cosmetic oculofacial plastic surgeon. And
understanding that it's critically important to first define what the issues are that result
in your lower eyelid appearance. Let's put aside what type of doctor is qualified or
is best for you but first analysis is very important.
As a specialist, with an eye surgery background and specialized training in cosmetic surgery
of the eyes, I could tell you that the anatomy of the lower eyelid is one of the most challenging
areas to work with because of the critical structures needed for proper lower eyelid
position. If you look at people who have had eyelid surgery, you'll probably find that
a lot of people, their lower eyelids are pulled down or rounded and they look like their eyes
are bulging. Now that for is not an aesthetic that I like. In my practice, it's all about
people looking natural. I actually wrote a book a few years ago "The Fine Art of Looking
Younger". I feel that the character of your face is critically important.
When I looked at your photo, I noticed the outer corners are slightly down. Now it may
be that you never had very high almond shape to your eyes but I suspect given your appearance
that a combination of genetics and aging changes has probably resulted in some looseness. And
so what you interpret as loose skin can also be contributed by something called lateral
canthal tendon laxity. Now the lateral canthal tendon is the support that keeps the eyelid
attached to the bone. When I describe the scenario of people having their eyes rounder
or pulled down, most of the time it's because of a board certified plastic surgeon or somebody
who's pretty qualified did not address that lateral canthal tendon. So that's one aspect
of the procedure that I think has to be important for you to understand.
When I do an evaluation of the lateral canthal tendon, we do something called the pull test
and a snap test to see how much spring there is to the lower eyelid. Then we look at the
amount of fat that's under the eye and whether or not there's extra skin.
Now, as far as choosing a surgeon is concerned, the field of cosmetic surgery, there are many
types of specialists. And one of the things that's really good for patients is the ability
to do research and learn about levels of specialization and training. But I think the factor that
is as important is experience. Every type of surgeon, whether they're general plastic
surgeons, oculoplastic surgeons, facial plastic surgeons will do eyelid surgery. However,
everyone has their own style and there are different levels of experience and practice
focus that helps distinguish one doctor from another.
So understanding that the functional aspect of the lower eyelid and the complexity that
is often missed on how lower eyelid surgery is done can basically be a caution for you
to do the research and understand that level of expertise that your doctor has. Now usually
patients will look at pictures of before and afters and get a sense of the doctor's style.
And in addition, I feel that it is important for a patient to feel that the doctor can
handle the different levels of complications. Now there is first level, second level and
of course more very advanced issues. But I think that most patients feel that an experienced
doctor who could handle any issues because no surgery is without some risk and so, feeling
comfortable with that is something that could be advisable. So, that being said, doing some
research and meeting with doctors and understanding what the risks are of the surgery.
Another aspect that I should mention is how the surgery is done. Whether it's done under
general anesthesia or whether it's under local anesthesia with sedation. In my practice,
I pretty much do things exclusively under local anesthesia with sedation. In particular,
when I do eyelid surgery, I like to do the procedure in a way where the patient is asleep
but I can wake them up pretty easily. When we are doing the art of the lower eyelid surgery,
even though people are afraid that they'll move or there'll be pain, that's not an issue.
When we are doing the lower eyelid procedure, when we're doing a tightening and we want
to get a nice shape and symmetry, well, we can actually ask the patient to open their
eyes during the procedure and we'll actually sit the patient up. Now this again is done
in a case by case. It's not a hundred percent. But this is one of the things that is a nice
aspect of doing this procedure to get that precise and natural appearance.
So I think that you have some research to do and ask those questions and learn more
about different doctors who perform eyelid surgery in your area. And hopefully you'll
make a good decision and be happy with your results. So I wish you the best of luck, I
hope that was helpful and thank you for your question!