What to do about my under eye area?
I feel like I have volume loss under my eyes even though I was told by a doctor that the
areas weren't "sunken" in but just had dark pigmentation causing them to appear sunken.
But I doubt this is the case because even when I put on concealer, I can still see the
sunken area.
I think filler would be a good option even though I was advised against it.
Any recommendations?
Thanks :)
Thank you for your question!
So it appears that you have some volume loss under your eyes but you have some confusion
because the doctor advised you that there was pigmentation that possibly may be responsible
for that perception of the volume being sunken in.
so you submitted two photos.
So this is a scenario that can be very confusing.
I’m a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for
over 20 years and there has been certainly an evolution in the perception of this area
over these two decades.
When I look at a photo like yours, I would ask you to first understand some of the anatomy
so this way you could understand why there is some confusion and then you can come up
with some kind of plan based on this.
So looking at your lower eyelids, when I look at that area that looks like it’s sunken,
that area is referred to as the tear trough area.
Now this is an area where it’s very common for people to be concerned about hollowing.
Now above that area, that area which looks like from the photo that there is some puffiness,
that area is an area we refer to as the orbital space or an area where you can experience
lower eyelid fat prolapse.
From the photos you submitted, it appears that you actually have a bulge of fat and
so when you think about this relative hollow, it might be because the bulge of fat that
is adjacent is making that area look hollow.
If that’s not the case, that area represents some relative hollowing, then that’s a different
story.
But I’m just going to advise you based on what I interpret from just the photos in the
absence of a physical examination where I would ask you to look up and I would actually
see if there’s any fat pushing forward, so I can’t really tell you exactly but I
can give you an idea of the anatomy that we look at.
Then below the tear trough area or I should say lateral or to the side of it, there’s
an area where the bone and the cheek meet called the eyelid-cheek junction.
This is a scenario where it’s very common to lose volume from being athletic when you
are younger, genetics or as we get older, we lose volume and it becomes diminished and
sometimes we refer to that as the V deformity or lose of volume at the eyelid-cheek junction.
So you can see how there can be a lot of different way to interpret what this area needs to make
it look better.
So when patients come in, I basically do this systematic approach and if they have lower
eyelid fat prolapse, depending on the degree of fat prolapse, we can either choose to do
something conservative such as a hyaluronic acid filler like Restylane, Juvederm, something
in that family and that can be placed in the tear trough to reduce that obvious transition
between the puffy under eye bags and the relative hollow underneath.
If the fat pockets are more prominent, then we would usually recommend something called
lower eyelid blepharoplasty.
And in a younger person who doesn’t have extra skin or there’s no other indication
to go from the outside, we would typically perform a transconjunctival blepharoplasty.
Now to also to address some this doctors concern about the discoloration, I always educate
my patients that the eyelid skin is the thinnest skin of the body.
Many times, factors such as stress, environmental exposure such as sun, smoking can cause this
area to thin, very ashen, very irregular and very crepey.
What we do to help skin quality is we use a material that’s derived from your own
blood called platelet-rich plasma.
Platelet-rich plasma refers to the cells called platelets and the plasma that goes with it
in the absence of red blood cells which are responsible for wound healing.
And we learned from the technology already established in orthopedic surgery and oral
surgery that placing your own growth factors under the skin, in our practice, we have been
able to get a lot of very nice results in stimulating new collagen, improving quality
of skin with more blood supply and we’ve done this all over the face.
In fact we developed a method of hair loss treatment combining platelet-rich plasma with
a material called Acellular matrix or extracellular matrix.
But that’s addressing skin quality.
And in select people, we would also consider a laser such as a fractional CO2 laser.
Then moving to the eyelid-cheek junction, we would also consider using hyaluronic acid
fillers in that area.
So when you hear this many options, it can be overwhelming and I think the goal of this
medium is to at least introduce them to you so you can at least have some the terminology
that would help you understand what the situation might be in your case and when you are ready
to take the next step, meet with qualified and experienced surgeons who can help guide
you.
I realize that you have been to one doctor but when something like this, you probably
need to meet with more than one until you find a doctor that you feel comfortable with
and trust and feel like they have the level of expertise in this area.
Not all doctors have the same level of expertise in a given area so you have to identify in
your level of comfort a doctor who have the level of expertise that you would feel that
you can trust.
So again, there are different factors that can be contributing to this relative hollow.
One of which can be a relative bulge above that relative hollow so again, meeting with
doctors to learn about these different anatomic spaces and how to address them and maybe it
will mean taking small steps when you are trying to figure out what would be a satisfactory
result and will make you happy and not feel so concerned about this area.
So I hope that was helpful, I wish you the best of luck and thank you for your question!