Facial fillers or lower lid surgery?
Hello I'm 28 years old and unsure of which route to go.
Thank you for your question!
You’re 28 years old, you submitted a single photo and you’re asking whether to have
fillers done to improve the under eye area or to have surgery. Well, looking at your
photo and although we don’t see a side view, I think it’s reasonable to conclude that
you have a significant amount of puffiness under your eyes. And I understand why you
are confused because when you do research on how to treat under eye bags, you see these
conflicting options and naturally, it’s confusing.
Well, I’m a cosmetic oculoplastic surgeon. I specialize in eyelid surgery and I do a
lot of under eye bags treatment. So I can share with you my experience being able to
do both the surgery and the injection on what my threshold is as to how I make the decision
between fillers versus surgery. Let’s start first by learning what is the underlying issue.
The underlying issue is an anatomic change. That anatomic change is called lower eyelid
fat prolapse. Lower eyelid prolapse means that the puffy bags represent fat and this
fat is normally behind a structure called the septum. It shifted forward and creates
these permanent bags. This appearance that you always looks tired, always look sleepy.
Now that means that there are different degrees in which the puffy bags prolapse forward.
We refer to it as lower eyelid fat prolapse. When it’s very slight and typical history
is when a patient says that they have a lot of good days but occasionally some bad days.
That typically means that there’s a little bit of puffiness and there are times when
they see it more than others but it’s very slight. Those patients tend to benefit with
filler because there’s not a lot to camouflage. The point of a filler is to soften the contrast
between the puffy bags and the adjacent tissue. And that area we refer to as the tear trough
or the eyelid-cheek junction and that continuous area, we can strategically and artistically
soften with the use of a filler such as a hyaluronic acid.
Now, as a specialist, I get to see lots of people who have puffy under eye bags who had
way too much filler placed under their eyes because a well-meaning doctor wanted to try
to help them to avoid surgery and they end up with so much volume of hyaluronic acid
under their eyes that they actually look even puffier and they look weird. And so we end
up using a chemical called hyaluronidase which is an enzyme to break it down and make the
stuff disappear.
So I think that from the photo you submitted, I think you are probably better off with surgery.
Now naturally when you’re 28, you wonder why at this age are you having cosmetic surgery.
But I can tell you that the puffy under eye bags is not the same category as let’s say
a surgery related to facial aging such as face lifting which is really more consistent
with the middle to later decades of life. We’ve operated on people as young as 14
for under eye bags and this is because this is a genetic issue. And so you can be very
young and still have under eye bags. The point is, when you think about surgery, there are
naturally hesitations. So I’ll let you know what we do in our practice to help our patients
overcome that.
First of all, we do our procedures in our own Joint Commission approved facilities.
This is the same certifying body that improves hospital facilities. So we’re committed
to safety and ensuring that our patients have no less quality of care and are really have
optimal care in terms of safety. The other aspect of this is doing the procedure in our
facility within our office. This is a much more friendly and less threatening atmosphere
than someone going in to a hospital and then going through multiple departments and kind
of the dehumanizing aspects of institutional care.
And on the top of that, we do the procedure under local anesthesia with LITE™ IV sedation.
This means that we don’t do general anesthesia and our patients feel comfortable that they’re
not going to be out and on a respirator like you would be on general anesthesia. We can
also do these procedures on straight local anesthesia with patients wide awake and we’ve
proven that for years and the safety record has been great and there has never been an
issue. So putting all those things together, it’s almost like the surgery is not that
different from having the injectable.
In additional to that, people are also afraid bruising and swelling after surgery. Well,
with this process that we have in our practice and the experience that I’ve gained over
20 years, we’re really able to effectively minimize bruising after surgery. And there
are many times people have come and see us after one week after surgery and they virtually
have no bruise at all and you I would argue that you can get more bruising with getting
injectables often times than surgery. Of course, it’s always a case by case basis.
That being said, based on your photo, you are probably a candidate for surgery. Now
what type of surgery? The procedure that I typically do for under eye bags is something
called transconjunctival blepharoplasty. One of the other objections people have is a fear
of scars and they desire to avoid some kind of external scars that shows that they had
surgery. So what we do is we do a procedure where we work from the inside of the eyelid.
And by working from the inside of the eyelid, we are able to reduce and reposition that
fat as is appropriate to get a very nice natural appearance and there’s no external incision.
So people feel comfortable and confident that no one would ever know that they had surgery.
I think that under eye bags make such a tremendous impact on a person’s facial appearance.
It’s no secret that it’s one of the most popular we do in our practice. And it’s
literally like doing a facelift where the eyes being brighter and more open and not
looking tired, it really brightens up the whole face. So I think at this point you should
meet with qualified experienced surgeons and learn about your options. Make sure you go
to someone who is a real expert in eyelid surgery. I’ve always been a firm believer
in specialization and helping the patients get the best results by seeing people who
are really experienced in any particular surgery. It’s no secret that surgeons who do a particular
thing a lot tend to do them very well. Of course you also have to look at the artistic
style and whether or not you’re comfortable with the doctor. That’s more of the intangible.
So I hope that was helpful, I wish you the best of luck and thank you for your question!