Thank you for your question.
You submitted your question with a photo and you’re asking what to do about under eye
bags that appeared about a month ago suddenly. Well certainly, I can give you some guidance
as to my impression based on your single photo in the absence of a physical examination and
share with you what I tell my patients who have similar situations as yours.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. Helping people with under eye bags is something we do in our practice
every day. And certainly, this type of scenario where patients come to me and say suddenly,
overnight, they have under eye bags.
Well, I can tell you that from my perspective, just understanding the anatomy that I think
it’s a little bit unusual for someone to have as they described, the perception and
the true reality or I should say there’s a distinction between the perception and the
reality. One likely scenario which is more plausible is that you’ve had varying degrees
of puffiness and at a certain point, it’s reached a point where it’s constant and
that it is always present. A lot of times patients will tell me that there was a time,
before they came to consultation where they would get puffiness but they would do a variety
of things and they would get a good night’s sleep and they would look good the next day.
But it would be, as described often as not so good days compared to very good days. And
essentially, the not so good days outnumber the good days, you often find yourself seeking
attention.
So that being said, it is always important that if there’s a big change in your appearance
that you always check with your medical doctor and make sure that your general health is
fine and that there’s no issue with kidney function, liver function, etc. But assuming
that you are healthy, I think that what you can at least understand is what is causing
the puffiness.
And from this photo, it looks like what you have is lower eyelid fat prolapse. Lower eyelid
fat prolapse is essentially describing what occurs when the fat that’s normally around
the eyes pushes forward and creates this bulge that results in this constant puffiness. Routinely
in our practice, for people like yourself, we do a procedure called lower eyelid blepharoplasty.
And what that means is the puffiness is addressed surgically.
Now most people are hesitant to want to have surgery and try to avoid surgery by doing
non-surgical things whether it is creams or injectables. And so certainly, there’s a
role for non-surgical options. In our practice, I routinely help patients who have mild amount
of puffiness under the eyes with injectable fillers to help blend the transition between
the puffiness and the tear trough area. In your situation however, I think that the puffiness
is more prominent and that it is likely to be more of a surgical solution.
Now when choosing a surgical solution, there are two options: one is doing the procedure
from the outside called transcutaneous blepharoplasty and the other is to do it from the inside
called transconjunctival blepharoplasty. In my experience and for a wide range of patients,
I routinely address the fat pockets specifically from a transconjunctival approach. That means
working from behind the eyelid to address the fat pockets and reduce them and sculpt
them accordingly.
A lot of times, people are afraid that if we do just that, what are we going to do about
the skin? Won’t there be excess skin? And I help patients understand that it’s not
really excess skin most of the time, that it’s actually about skin quality and not
skin quantity. In particular, for males and for people who are in their 40s and older,
tendon laxity and support of the eyelid is very important. And so, there are other variables
that also play a role in this decision making. Unfortunately we have patients who come to
us from all over the world with complications because their eyelids would be retracted or
everted from having surgery done in a way which doesn't address all of the anatomic
variables that can affect the position of the lower eyelid and such that they need revision
surgery and often complicated revision surgery.
When I am asked about skin quality or wrinkling under the skin, I tell my patients that we
routinely help our patients with under eye wrinkling and skin quality with a combination
of platelet-rich plasma (PRP) which is derived from your own blood and stimulates collagen
and improves the skin quality combined with laser. And laser whether it’s fractional
CO2 laser or Erbium laser is able to freshen up the skin and improve some of these texture
issues and globally between the puffiness and the skin quality improvement, you look
better. And what’s really great about the under eye area is that it has such a big impact
on the whole face because bags under the eyes really makes the face look tired.
So I think that you’re on the right path. And as far as the issue of overnight, as I
said, make sure you see your medical doctor just to make sure everything is okay but I
think more likely, this is just a cosmetic issue and that it is a change that has become
more persistent. And so you are appropriately in a situation that can be addressed surgically.
So meet with qualified experienced cosmetic surgeons and learn about your options. Learn
about the style in which your doctor approaches this issue. Look at before and after pictures
and as often is the case, people also want to choose a doctor based on the type of anesthesia
they have to undergo. We have patients who come from all over the world who come to me
besides the reason of specialization because I do these procedures in my office under local
anesthesia with LITE™ sedation thereby avoiding general anesthesia altogether. This way, our
patients are able to be up and ready to leave without feeling any of the nausea and issues
related to general anesthesia. Again, it has to do with the surgeon’s preference and
whatever makes the surgeon of course comfortable but in my practice, we developed a nice system
and it works out very nicely to help people have the procedure with minimal sedation so
that they don't have the anxiety of experience in the procedure and again, avoiding general
anesthesia and being able to comfortably heal and get back to normal life in less than a
week.
So I hope that was helpful, I wish you the best of luck and thank you for your question.