Thank you for your question.
You submitted your question with a single photo.
And you’re asking if you have one significant under eye bag compared to the other eye or
is there a reason why people keep asking you if you have a black eye.
Well, I can certainly share with you how I discuss this type of concern to my patients
in the absence of more details of your eyes and a physical exam.
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 to have better looking eyes is a big part of what I do every day in my
practice.
Everything ranging from treating under eye bags with surgery as well as with injectables,
the use of lasers and other technologies and techniques to help people look better.
So I can guide you a little bit of what I do when I make an assessment of discoloration
or perception of discoloration.
Now when I look at your photo, it does appear that there is a difference in the color of
an area under one eye compared to the other.
One area looks like there’s pigmentation.
So when patients come to me and often a common concern is about dark circles under the eyes.
I explain that essentially, we have to look at the anatomy whether it’s from the outside
in or the inside out, would have to do it in a way that is logical and sequential.
So let’s start from the outside in.
When you start with the outside, you look at the skin.
In the skin, what is responsible for the perception of pigment?
Is it from the external skin having a lot of pigmentation from sun exposure or from
previous trauma?
Is it pigmentation that you’ve always had such as one that you are born with and that
type of pigmentation brings to mind conditions such as something called nevus of ota or different
types of melanosis where there’s high concentrations of pigment in an area that is something that
you are born with.
And further, as you go further back, you also look at the shadow under the eyes and that
is often the result of genetics in terms of anatomy as well as from the blood supply or
vascular system or the veins under the eyes.
Last and is also important as you asked in your question is the presence of an under
eye bag.
And that is essentially represented by an anatomic issue called lower eyelid fat prolapse.
When there is a certain amount of lower eyelid fat prolapse, a lot of times the under eye
bag is overlooked and the relative hollow is perceived as a dark circle.
And so solutions as you can appreciate from my describing the different type of anatomic
condition also are based on the anatomic issue that can be approached.
So for example, if we are dealing with pigmentation or skin quality, then there is a wide range
of different lasers and technologies that can be applied to treat the skin from that
perspective whether it’s specific to the pigment or something to resurface the skin.
When we look at the relative hollow in this area, well injectable fillers such as the
use of Restylane to help soften the transition between the bag and the hollow.
If an under eye bag is so significant that it isn't treatable or manageable with a filler,
well then surgery is appropriate, surgery such as something called transconjunctival
blepharoplasty.
So I think that, although you are looking for some guidance by submitting a photo, I
think it’s very important to meet with a qualified, experienced doctor.
I would suggest considering someone who is an oculoplastic surgeon who is a specialist
in eyelids who understands this area very well and who is very experienced in this area
who can give you a very thorough evaluation and explain to you what are the reasons for
this issue with this perception of black eye.
I think you’ll find that to be helpful and help guide you as to how to approach this
issue and see what kind of treatment strategy is best for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.