Thank you for your question.
You submitted a question with a single photo and you state that you’re 25 and that you’ve
always had under eye bags and you’re looking for a way to address these issues. And you’re
asking about creams and other options.
Well, I can certainly give you my perspective as a specialist. 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.
And I can tell you that I’ve dealt with a lot of patients with exactly this type of
situation and I’ll share with you essentially what options I present at this current time.
Under eye bags is probably the most common procedure that we perform or helping people
with under eye bags is the most common procedure in our practice.
So to begin with, it is extremely common for a person like yourself to state that they’ve
always had these under eye bags. In fact, people who come to me in their 30s and 40s
will say that they’ve had under eye bags since in their teens. So a question occurs
now is what is the best way to treat these under eye bags?
Well, as of recent history, in the past several years, the options have become essentially
to do something that is a filler versus doing something surgical. And although, and I perform
both in my practice. And certainly, just to deal with what is considered or perceived
as less invasive, although fillers, you’re basically going through the skin, it’s in
my mind no different from doing surgery. But in terms of the placement of fillers, fillers
can be effective and help to soften the transition between the deep area of the tear trough relative
to the under eye bag.
And speaking of the bag, it’s important to understand what the anatomy here is so
you can understand the principles of the solutions. The under eye bag represents something called
lower eyelid fat prolapse. Lower eyelid fat prolapse is essentially the movement or shifting
of fat that’s under the eyes, forward. Now of course, this is something that you’ve
always had so it’s not an age-related thing. It’s an anatomic thing. The solutions in
front of you are basically ways to either soften the appearance or to surgically reduce
the fat pockets.
So when it comes to the question of age and at 25, you may feel that you’re too young
to have this procedure. Well the reality is that there are plenty of patients I have operated
on in my practice who are your age and younger. And essentially, the problem has to do with
or actually, you pursue the solution when you have the problem and the problem is significant
enough to do some kind of intervention. So in my mind, for a 25-year-old, it is less
practical, in terms of this time of your life, to keep going to a doctor’s office to keep
getting injectables if you can have an alternative that may provide you more long-term more definitive
solution. So my, based on just the photo and not a physical examination, I would lean towards
having you undergo a procedure called transconjunctival blepharoplasty. Now what that means is, under
local anesthesia with LITE™ sedation, I would address the fat pockets from the inside
of the eyelid. That means reducing, dissecting or removal as well as repositioning as is
appropriate so that you look as if you never had the under eye bags. This procedure works
very well. It’s essentially a procedure than can last a very long time particularly
when you do it at this young in your life. And it will, more definitively, deal with
the anatomy of your issue.
Now something to, as a side note, a lot of times when people have this type of issue,
they also happen to have relative hollowing of the cheek area and it’s something that
I point out and it’s not hollowing in terms of aging but more of hollowing just as a matter
of anatomy. And so I also discuss the options of augmentation of these areas but it does
bring us back to considering fillers and other things.
A lot of times with the lower eyelid blepharoplasty, I will combine that with PRP to help improve
skin quality and discolorations and maybe help improve some volume in this area. PRP
is platelet-rich plasma. It’s derived from your own blood and it’s routine for us to
do this at the same time as the procedure to maximize the aesthetic outcome because
we’re now improving or we’re taking away the fat pockets but we’re also improving
skin quality.
A lot of times, I suggest to my patients is do the procedure, see how you look afterwards.
If anything draws your attention, then we can always consider procedures that might
help further maximize your appearance. But I think that based on this photo, I would
probably lean towards lower eyelid blepharoplasty. Again, in our practice, we perform these procedures
in a Joint Commission certified facility which is the same certifying body that certifies
hospitals and surgery centers. So we’re able to provide the safety and the standards
of quality but at the same time, do it at the office setting under, again, local anesthesia
with LITE™ sedation.
So I think it’s important for you to meet with qualified, experienced cosmetic surgeons.
Look at their results. Look at their level of experience with doing this type of procedure.
See if you like the outcomes and I think you’re more likely to get what you want more definitively
with that approach. Again, a physical exam is very important to really make a definitive
recommendation.
So I hope that was helpful, I wish you the best of luck and thank you for your question.