Thank you for your question.
You submitted your question with several photos.
And you stated in your question that you’re 49-years-old and that you finally had the
time to address the appearance of your under eye area, that you’re new to the surgery
scene and you would like some guidance as to what to do to help the puffiness and droopiness
of your under eyes.
Well, I can certainly share with you some basic concepts that I discuss with my patients
who have similar situations and I think it’s very important with your very unique anatomy
to understand some of these principles which can often be overlooked.
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 the under area has been a very important part of my practice.
And as a cosmetic oculofacial plastic surgeon specializing in aesthetics, I also do a lot
of revision eyelid surgery for complications.
And I think that your anatomy is something that you just be mindful of in determining
the best strategy that’s right for you and I’ll go further as to what I mean.
So to begin with, when you look at your eye structure, it’s very important to understand
that the under eye area has many important anatomic elements that need to be balanced
in order to maintain a natural shape and maintain function and to avoid a lot of the problems
that can occur.
So to begin with, let’s first start by defining what some of the issues are.
And it’s also important to understand when you look at your under eye area, that you
can also look at the under eye area and how it relates to the cheeks.
You know, when people come to me and want to help their appearance under their eyes,
very often they look so intently or so focused on the eye area, they miss part of what’s
surrounding that area.
And so what I try to explain is that when you look at someone’s eyes, you also look
at their cheekbones.
You look at this whole area.
And it’s important because there’s a harmony that can potentially be achieved by managing
both areas and not isolating the work under the eyes but there are some key principles
to understand.
For one thing, your eye is relatively prominent relative to the cheekbone.
Now with facial aging, cheek volume diminishes and the eye socket changes and this is due
to bone loss.
And so it’s a very important variable because when you perform eyelid surgery, you want
to ensure stability of the eyelid position.
That being said, let’s begin with the first issue of what helps people look better under
their eyes and that has to do with something called lower eyelid fat prolapse.
What this means is that the fat pockets that are around your eyes, pushes forward and creates
a bulge of fat.
With someone with prominent eyes and someone who is male, we generally do this procedure
from the inside and the procedure is called a transconjunctival blepharoplasty.
What this means is that the fat pockets that are underneath the eyes are reduced from the
inside of the eyelids.
Now this is very important because the key here in your situation would be to maintain
the support under the eyes of the muscle like the orbicularis oculi muscle which acts like
a hammock to hold up the eyelid.
It is not unusual for a lot of doctors to perform this procedure from the outside with
the intention of removing skin to try to help people improve the appearance of excess skin
or the appearance of wrinkles.
Unfortunately, that can result to complications which is called ectropion or lower lid retraction
and that is something that I would caution you about given your anatomy.
Further with the under eye area and this is only with a physical examination, we have
to determine this but it’s also important to deal with something called lateral canthal
tendon laxity.
When I look at your eyes, it looks like the tendon that helps support the eyelid may also
need reinforcement.
And that’s also something that has to be addressed.
It’s also possible that you may need some support under your eyelids which means additional
structural support to help the position of the eyelids.
So it’s not so straightforward.
It’s just doing something that’s cookie cutter.
Further, just to finish the thought about the cheekbones, there are times where there’s
a value in helping create volume in the cheekbone.
Now this can be done with a technique called Structural Volumizing and this is a procedure
where we use a long lasting filler such as Juvederm Ultra Plus and Juvederm Voluma and
we can do that at the time of surgery to enhance the cheekbone to create a balance and harmony
that helps the eyes look better.
So I think it’s important that you meet with qualified, experienced cosmetic surgeons
and I would add to it that you consider choosing an oculofacial plastic and reconstructive
surgeon because of this super specialization of the eye area and familiarity with the complexities
of balance of the lower eyelid that I think are particularly relevant in your situation.
So learn more about your options, do your research.
Come to your consultation with a good list of questions and see where you’re comfortable
and then proceed.
Certainly, there are a lot of choices.
You want to be sure most importantly that your procedure is done in a way that maximizes
the integrity and the function of your lower eyelids in addition to improving the aesthetic.
So I hope that was helpful, I wish you the best of luck and thank you for your question.