Thank you for your question.
You've submitted two photos, and you're asking about whether you'd be a better candidate
for fillers for under eye bags versus fat transfer for the under eye bags.
So I think I'll be able to help you a little bit with this question.
Just to give you a little background about myself, I'm a Board-certified cosmetic surgeon,
certified by the American Board of Cosmetic Surgery.
In addition, I'm also a Fellowship-trained oculofacial plastic surgeon.
I'm a specialist first trained in eye surgery, and a super specialist in plastic surgery
of the eyes—that’s a distinction from general plastic surgeons who are more broadly
trained from head to toe, but are not specialized in one specific area, unless they do additional
Fellowship training.
Just to give you a little bit about my experience, I've been a practicing cosmetic surgeon in
Manhattan and Long Island for over 20 years.
So to address under eye bags, we first want to make some diagnosis as to what exactly
is the issue before you make a decision on choosing fillers, fat grafting, or any other
option.
With the photos you submitted, I think that what you describe as under eye bags is to
do with a muscle.
Because the photos you submitted, it appears that you're smiling, and if you're smiling,
even if you have puffy under eye bags, which are caused by lower eyelid fat prolapse, then
you can often push back those bags.
But if what bothers you is this bunching up under the eyelashes, which are in the photos,
then I would say that neither fillers nor fat grafting is appropriate, because the reason
the skin is bunching up has to do with the muscle.
There is a muscle called the obicularis oculi muscle.
This is a muscle that's activated when you squint, when you blink, when you smile.
And when that muscle is very active, if you feel that there's been a change from the way
it used to look, then I would say that adding volume in this space, which we’re focusing
on based on the photo, would actually make the areas look worse.
Adding filler, adding fat, will not improve those areas.
An option that is suggested at times when patients come into our practice is to use
something like Botox or Dysport.
These are injectables that will actually relax the muscle.
There's a distinction between Botox or neurotoxins versus fillers, which add volume.
Neurotoxins relax muscles.
Now there is a possibility that you'll get some improvement, but from my experience,
the bunching of skin from the act of smiling is not just a function of that muscle, it's
also an accordion effect.
As the cheek moves upward, it compresses all of the skin and muscle and it creates some
thickening in that area.
Now a lot of times, when patients come to me with this concern, I step back and I look
at them and I ask them why does it bother them, because I think that what a lot of people
do if they notice something they don't like about their face and they zone in on it.
It's a psychological reality—we all look at something in ourselves that is maybe small,
and then we magnify its importance.
While other people look at us and they see the big picture.
So I think you should meet with qualified, experienced cosmetic surgeons so that you
can learn about the distinction of what the eyebags are that you're referring to, and
again, make a determination as to how much they bother you.
The nice thing about using a medication like Botox or Dysport is that it has a short activity
lifespan in terms of the longevity, about a three to six months range.
So if you like it, great, you can continue doing it.
If you don't like it, then you don't do it again.
But again I would caution you to set expectations appropriately, because it may not be worth
the investment in time, and financial investment, to do something when you may end up with a
more subtle result, so that's also important to consider.
So I hope that was helpful and I wish you the best of luck.
Thank you for your question.