Is there a solution to my under eye bags other than surgery?
I was told injections are not an option for me. Are there other solutions to my eye bag
problem? Please Help.
Thank you for your question!
You submitted a single photo and you’re asking is there a solution for your under
eye bags without surgery and you were advised that injections were not an option. Well,
let’s take a look at your photos and let’s analyze what’s going on. I’ll share with
you my approach when I meet someone like yourself in my practice.
I’m an oculofacial plastic surgeon, practicing in Manhattan and Long Island for over 10 years.
This means that I first had a background training in eye surgery and specialized training in
cosmetic and reconstructive surgery of the eyes and face. Under eye bags is an issue
that we deal with in our practice. The desire to avoid surgery is always natural. And when
we look at your eyes, we see significant puffiness under the eyes. In addition, as a side note,
even though you didn’t mention in your question, that your upper eyelids are relatively low
and I would say you appear to have a condition called ptosis or drooping of the upper eyelids.
Getting to the lower eyelids, essentially what you are dealing with is an anatomic issue.
That means that the fat that’s normally around the eyes have pushed forward and created
this bulge and puffiness. And so naturally, there is no way to push the fat back and reinforce
it without some type of surgical procedure. What we refer to as lower eyelid fat prolapse
or herniated fat, you can think of it almost like a hernia in another part of the body,
you have to have some type of surgical procedure.
Practicing for over 20 years, I’ve learned a lot from my patients as to what are the
concerns of having surgery. I would say in terms of the concerns has to do with aesthesia.
In our practice, what we have developed is a method of sedation which means, instead
of going under general anesthesia, which is usually a less appetizing prospect when you
have to think about put on general anesthesia where a tube is put in your throat and your
body is paralyzed and you put on a respirator, that can be pretty intimidating. What we do
is local anesthesia, that means going into the dentist’s office and getting a little
injection of local anesthetic but at the same time, we give you some LITE™ sedation and
this has is something that has been very successful for us. We’re able to make our patients
comfortable and at the same time, avoid general anesthesia and do the procedure very efficiently.
A lot of times, a lot of people also feel that injections are less invasive than surgery
but the reality is that once you’ve gone pass that superficial level, it is invasive.
Injectables can create complications and problems including infections or something called embolization
where it can go into vessels you don’t want to be in and create problems that one would
never expect because it seems innocuous to have an injection but an injection and surgery
are more similar than you would believe from a non-medical perspective.
So someone like yourself, someone with dark skin, someone who doesn’t appear to have
excess skin, what I would generally do is a transconjunctival blepharoplasty. Now it
is a mouthful and it basically means that I work from the inside of the eyelid and that
way, I can avoid any external incisions and scars. It’s very important for people with
dark skin to be mindful with the issues of pigmentation related to incisions, hypertrophic
scars or thickened scars very often referred to as keloids. And of course, all of these
subtleties that have to do with the unique issues of different ethnic skin types.
Many years ago, I wrote a book called “Ethnic Considerations in Eyelid Surgery” and I
tried to explain to every patient that there are unique issues that are related to the
genetics and the anatomy of different ethnic backgrounds that have to factored in in terms
of the method of the surgery as well as supportive procedures. We routinely apply the use of
something called platelet-rich plasma to help skin quality. Platelet-rich plasma is derived
from your own blood and what we are doing is essentially concentrating the wound healing
and growth factors that help stimulate collagen, improves color, improves quality and improves
the blood supply of the skin.
So this method of combining minimally invasive approach which is from the inside of the eyelid
with local anesthesia with LITE™ sedation combined with platelet-rich plasma has been
a very good method for us in our practice. For over 20 years, this has been a major focus
for us and we certainly find this procedure to be very gratifying. If there’s one thing
many people would do in their whole life in their face, it will be addressing the puffy
bags under the eyes. I’m always impressed how it brightens the whole face with the bags
gone and it just makes the eyes look more bright and awake.
In your situation, you may also have to explore ptosis. I don’t want to add more anxiety
to your life but I think it’s important that you understand all the issues so that
if you move forward with the procedure, you’ll learn all of the things and not just partially.
A lot of times, communication is the biggest challenges between plastic surgeons and patients
and so in our practice, it is teaching and educating is of the highest value for us so
that our patients really understand what their risks and benefits are before they move forward
with the procedure. In our situation, a more extensive examination will at least reveal
your issues and then you can decide if and when you want to deal with them. Just because
you have these diagnoses, doesn’t mean you have to address all of them but you have to
set expectations appropriately.
So I think that if you want to reduce the puffiness under your eyes, you’re going
to have to embrace and get used to the idea of having this some type of surgical procedure.
Meet with cosmetic surgeons, review their results. Get a sense of the feedback of how
their patients recover and take it from there. But I think that once you do this, you’ll
experience what a lot of our patients say. a lot of our patients say “If I know that
it was this easy, I would have done it sooner.” I’m honored and flattered by that but I
never say that the procedure was easy, but it is certainly predictable within reason
to get a nice result. Again, it’s all about communication and management of the procedure
in the most optimal way.
So I hope that was helpful, I wish you the best of luck and thank you for your question!