Thank you for your question.
You’ve submitted several photos from multiple angles of your eye area and you stated in
your question that you’re 21-years-old.
You’re aware of a low iron level and you are well aware of other variables that are
contributing to under eye bags.
And you’re looking for some guidance on what to do.
Well, I can certainly help you understand what my impression is based on the photos
you submitted.
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 helping people with under eye aesthetics has been a significant part of my practice
for decades.
And we offer a wide variety of solutions.
But it’s very important to first understand the anatomy before you start looking for solutions.
So to begin with, what do we see when we look at the photos?
Well, the photos, my impression is that you have what’s called lower eyelid fat prolapse.
Lower eyelid fat prolapse is an anatomic description of the fat pockets that’s specifically around
your eye that have pushed forward and created this puffiness under the eyes.
Now, part of the irony of the situation is a lot of times people don’t notice the puffiness
but are bothered by what they perceive is a hollow and this hollow is the area adjacent
to the puffiness referred to as the tear trough and the orbital rim area.
So when it comes to solutions, you are essentially looking at two different perspectives: one
is to try to blend the appearance of the puffiness by adding volume in the area of the tear trough
and the other is to reduce the puffiness by addressing it in a way so that the puffiness
is no longer present.
So generally speaking, it’s really a matter of a proper physical examination and making
a decision as to what you’re comfortable with.
When it comes to first more of the conservative option, the use of an injectable filler such
as in the hyaluronic acid family such as Restylane is something we do routinely.
We place Restylane into this area called tear trough and it can really do a nice job of
camouflaging and blending the interface between the puffy under eye bag and the adjacent area
thereby creating a more of an even contour.
Interestingly, although Restylane would typically last only about 6 months in other areas, it
is not unusual for this filler to actually last longer in this area.
Now, with the appeal of something like this as a strategy is of course it is minimally
invasive.
It’s done in an office setting.
A little bit of local anesthetic and the techniques that I employ actually uses something called
cannulas where I place this filler as minimally traumatic with the lowest risk, in my opinion,
of bruising in comparison to direct injection.
Now that is one plan and one option.
The second plan or option would be to do a procedure called a transconjunctival blepharoplasty.
In someone who is relatively young who has lower eyelid fat prolapse, it is my approach
to always to do this procedure from the inside of the eyelid.
Of course, you don’t always say always but essentially the probability is doing it from
the inside, basically avoiding external incisions as well as avoiding of course stitches.
And so by doing it from the inside, we’re actually able to sculpt the fat and reduce
it in a way so that it contours the skin such that it would appear that you never had the
fat pockets there.
Now a lot of times, people who are relatively young like yourself are very hesitant to do
anything because they feel they’re too young to do something and certainly, that’s an
understandable perspective.
I can tell you that my youngest patient for under eye bags which of course, was considerably
larger than yours was a young man who was 14-years-old.
So it’s not necessarily an age issue but thanks to the different options I described,
fillers can maybe be a good way to address the cosmetic appearance until you are ready
to do something else or it maybe something that you are able to do for years depending
on how much more prominent the under eye puffiness becomes depending on your genetics as well
as your environmental factors.
So I would say, meet with qualified, experienced surgeons who do both injectable fillers as
well as surgery and have a lot of experience with the under eye area.
And you may want to just take the first small step of trying a filler and hopefully that
would be adequate for you.
But of course, there’s a difference between looking at a photo and seeing someone in person.
No matter how good the photos are, the photos are not a three dimensional representation
as a live examination.
And so, once that is done, the doctor is able to make a more informed assessment for you
and give the guidance that is appropriate.
So I hope that was helpful, I wish you the best of luck and thank you for your question.