Thank you for your question.
You submitted your question with several photos.
And you state in your question that you are 23-years-old, you underwent lower eyelid blepharoplasty
in 2014 and that you weren't satisfied with the results.
And you are asking should Pelleve be done for you because your goal is to have tighter
and normal looking skin.
And that you described that this area under your eyes is a result of a hereditary feature
and so you want to know if Pelleve makes sense.
Well, I can certainly share with you my perspective just based on your photos alone and how I
incorporate Pelleve and other modalities to help rejuvenate people’s under eye area.
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 achieve rejuvenation of the under eye area is a core part of my practice.
Everything from procedures such as lower eyelid blepharoplasty as well as the use of injectable
fillers as well as lasers and radiofrequency devices to help improve this area.
And so I think that it is important to make a distinction here and what you would expect
from the Pelleve procedure.
Now first, most importantly, it has to be determined, when you’re looking up, whether
that shape, that little crescent shape under your eyes is representative of fat or whether
it’s just an anatomical, essentially a shadow of the underlying structure as well as what
is the relative volume under the eyes relative to the cheeks.
The reason I say this is that it is straightforward if there is any residual fat that would need
to be addressed.
Generally speaking, in the central area of the under eye area, there is usually not that
much residual fat after lower eyelid blepharoplasty but that’s something that can be determined
during physical examination.
It’s important to make that distinction because even though you try to tighten the
skin which is what you are trying to consider with the Pelleve device, you aren't going
to be able to push the fat back.
It’s very important to understand that fat pockets have a significant amount of volume
and they will not just shrink back because you tighten the skin.
Now as far as the role of a radiofrequency device in your situation, I think that given
you are as young as you are, I would doubt that there would be a significant benefit.
Generally speaking, radiofrequency device and laser devices are more appropriate when
we’re dealing with a lot of the challenges that occur with progressive facial aging.
Skin quality thins, collagen diminishes and therefore thermal energy devices can be applied
to help tighten the skin.
Now further I would suggest to consider, since this is more of a genetic anatomic issue,
there may be some value in exploring the appearance of the eyes relative to the cheekbones but
also to explore the idea of maybe using a filler such as a hyaluronic acid filler to
help soften some of the areas where the under eye is hollow.
There is always a balance that we try to achieve to get the optimal under eye appearance.
Patients come who routinely have either the absence of under eye fat pockets or even minimal
or mild under eye fat pockets with a relative deep hollow in the tear trough area,.
They do very well with an injectable filler such as Restylane.
So I think that would probably be the next appropriate step in my mind for someone who
wants to improve this appearance.
It is important to understand that tight doesn't mean youthful and you are already very young.
So you wonder how much room is there for skin improvement.
Now of course I don’t know if you’re a smoker or have any other medical issues or
allergies.
But generally speaking, I tend to be more conservative when it comes to helping younger
people.
We have patients in your age group particularly many who are performers, who are actors and
they’re very sensitive by the way their eyes appear on camera.
So certainly, placing volume strategically probably would make more sense.
In one of these photos or at least one of them, you are making facial expressions and
if you are bothered by a fold of skin during facial expression, there’s no technology
that will diminish that significantly because it’s not just the activity of the muscle
but it’s the physical movement of the cheek upward that causes that skin to fold.
If you are going through a consultation with another physician other than the doctor who
did your surgery or the same doctor, it would be good to review your photos and what you
look like beforehand, before the eyelid surgery and then afterwards and then get a sense of
what is the true issue that can maybe be addressed with some type of filler or other modalities.
I think a lot of times many people look at themselves very critically and someone who’s
young can very be critical and that is something that is not unusual but it is important to
at least get some perspective.
And so, a lot of times, what I’ll do is I’ll take pictures and then I’ll review
them with the patients that we can get a sense of what exactly is the main issue and what
kind of outcomes can we achieve with any intervention.
Generally speaking, for a younger person, injectables usually is as much as I would
typically do unless there is a surgical indication such as additional fat under the eyes.
So meet with qualified, experienced doctors who specialize in this area and learn about
the options and take it from there.
So I hope that was helpful, I wish you the best of luck and thank you for your question.