I'm getting blepharoplasty soon and am worried about the "hollowed out" look I have been
reading about?
How common is this?
I'm in my early 30s and have had eye bags for the past 10 years.
I constantly get comments on how tired I look and finally have worked up the courage to
get it done.
However, I am apprehensive after reading many online reviews of dissatisfied patients.
How common is the sunken/hollowed out look after blepharoplasty?
Does fat transfer reduce the incidence of this significantly or marginally?
Does the fat transfer usually last forever or are revisions common years down the line?
Thanks!
Thank you for your question!
You're in your early 30s and you've had eyebags for about 10 years.
And you're planning to have surgery and you are of course concerned about hollowing after
looking at some reviews by people who have not so great experiences and you're asking
about fat transfer.
So this is a question that I deal pretty much every day.
Puffy bags under the eyes is one of the most common things that we take care of in our
practice.
And for years, I have had a lot of different perspectives as to the perception of what
hollowing is.
You see, hollowing can be defined in many different ways and unfortunately, there's
some subjective aspects to this.
In our practice, what we do is first explain to our patients that when you have lower eyelid
blepharoplasty, when you address the puffy bags under the eyes, what you need to imagine
if you could, is what would the eyes look like with the bags are not there.
You see, as I mention in my book, "The Fine Art of Looking Younger", facial aging is not
just sagging but it is also volume loss.
And it is my perception, that the people who are complaining about hollowing, are not only
referring to the under eye directly but also to the area below the eye, the cheek area.
As we get older, we lose volume in this cheek area, this apple, what makes the younger person
look younger,.
And so what happens, after the puffiness is addressed, a person may look at their face
and say they still look tired or hollow and if it wasn't addressed in discussion about
what can be done afterwards and naturally, they would feel that the fat removal made
them look hollow.
Now to address this hollowing issue in addition, a lot of my colleagues including myself, has
tried a variety of strategy for years this includes: fat transposition, fat transfer,
septal tightening.
And as a specialist, I have found out that, although much of this conceptually and theoretically
desirable, it is very difficult to accomplish in practical terms.
And there's basically one issue: the tissue, the quality and the integrity of the skin
under the eyes is very thin and it shows everything.
And so if you transfer fat under the eye to fill a hollow, very often people will look
bumpy.
Fat transfer is something I would do in areas that the skin is thicker.
I'll place it in the cheeks, I'll place it in the nasolabial folds, I'll place it in
the mandibular notch, I'll place it in the mesolabial folds or the marionette lines.
But the one place I won't place directly is the under eye area.
Anywhere that the skin is so thin, I have seen so many patients who have come to me
from all over the world who have had lumps, irregularities and scars from fat transfer.
The problem is, when you do fat transfer, you are not just transferring fat, you're
transferring fatty tissue.
And you can go to different types of processes to purify it but it has still been associated
with variability, need for additional surgeries as well as chronic and persistent swelling.
So I think you have to have a very clear understanding with your surgeon about what to expect after
the surgery and what can be done if there is an issue with relative hollowing.
For example, when I examine patient and I show them that there's the puffy bags but
then they have the relative hollowing in the tear trough area, well the option that we
can have after we're done with the surgery is that we can consider adding filler.
It's paradoxical that you have to much in one place and not enough in another but the
same is true in body contouring and other body procedures.
So it's having a plan and communicating the details of the anatomy so that the person
who's about to have the surgery can have a reasonable expectation of what would be the
improvement.
So with that understanding, I think you have to have this conversation with your doctor.
As far as reading online personal reviews about personal stories, I think that there
is no shortage of forums and other areas on the web where people were right about their
experience and so many of the best respected people who I know have been celebrated and
trashed at the same time in the same forum discussion.
So I think you can easily get yourself into the paralysis of analysis from just second
guessing and even though things may sound right conceptually, they may not be as practical
in the real world.
Again, meeting with your doctor and having a discussion about the realistic impact will
be with a lower lid blepharoplasty for you I think will help alleviate your concerns.
So I hope that was helpful and thank you for your question!