Thank you for your question.
You submitted your question with a single photo.
And you describe in your question that you have 30% bags under your eyes.
And that you have spoken to several doctors and each doctor has recommended to do a limited
amount of removal of under eye bags and a limited amount of repositioning in order to
avoid hollowing.
And you’re asking what can you do to ensure that your doctor just does the right amount
of both.
Well, I can give you some perspective on how I evaluate patients like yourself who come
to my practice every day.
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 people with under eye bags has been the core procedure that has been popular in
my career and I can certainly understand your conundrum and question about to how ensure
that you get the best possible result.
Well, as an oculofacial plastic and reconstructive surgeon, I can certainly tell you that having
experience from doing facelift surgery and doing a lot of injectable fillers, I try to
help my patients understand what their under eye puffiness impact is in the context of
the rest of the face and this is where things get interesting.
You see, when someone like yourself who has obvious under eye bags and particularly prominent
as you go from the center to the inner corner of the eyes, certainly, that’s a dominant
issue when you look at your face.
The face clearly is affected by under eye bags.
I often say that helping people with under eye bags is like doing a facelift.
It really transforms the whole face.
But during my consultations, I also point out to my patients that there are other variables
that contribute to this hollow look that is not necessarily just about the under eye bags.
So when you look at your face, you notice how there’s also a relative amount of volume
deficit in the cheekbone area, in the area directly below your eye also called the submalar
area.
So when someone like yourself comes to my practice, we certainly have this discussion
about removal of fat and repositioning.
But I would caution you about this concept of repositioning.
A lot of my colleagues have cyclically chosen to try to aggressively take some of the fat
from under the eyelid and place it right over the rim of the bone called the infraorbital
rim and place stitches to hold the fat in that position with the well intended goal
of trying to fill a relative hollow in what is the tear trough and infraorbital rim in
that area.
Generally speaking, there are two paths that occur.
One is that the fat doesn't really make it because of the bend and the vascular compromise
which results in the fat just disappearing and breaking up.
And two being there chronic swelling from congestion of fluid within the circulation
of that fat and lumps and bumps occurring until the doctor either chooses to inject
steroids or wait for the fat to just disappear.
Generally speaking, I would say that particular method has limited value particularly when
you look at the eyes and face as a whole.
It’s very important to understand that especially in the modern world, predictability is critically
important and understanding what is the balance in your facial architecture that would optimize
your appearance is something that’s not just accomplished by a single surgical procedure.
So my suggestion would be to consider doing a limited fat reduction, maybe some internal
reposition of the fat and I would explain something like this in person of how I would
do that but I would not recommend the over the rim suturing of the fat.
And I would rather actually use a long lasting filler such as Juvederm Ultra Plus or Juvederm
Voluma in the cheek area to help balance the hollowing appearance that is there with the
improvement of the under eye area.
So the irony is that there is a volume deficit in the cheek while there’s a fat prolapse
under the eyes.
So a lot of times, we can do this in combination during surgery or I give a lot of my patients
the option to consider doing fillers after the surgery but understanding what are the
limits.
So again, analyzing your face from a front view, at a three quarters view, a side view
and seeing that a little bit of volume in the cheek area can go a long way in maximizing
the overall aesthetics.
A lot of times, people are less than excited about considering injectable fillers because
of the maintenance involved.
And I would assert that given other alternative options including fat grafting, it is still
in my mind the most predictable and safest approach to getting an aesthetic result.
Very often, many people want the best of everything and have a single definitive procedure to
solve everything but there’s a reason why there are so many different tools in the aesthetic
field.
And so I would say that again, the importance of safety and reliable, consistent, predictable
outcomes cannot be overstated.
And certainly as a specialist, I take care of patients who come from all over the world
who have had problems with fat grafting or with fat repositioning, with eyelid retraction,
with other problems related to many of these procedures that I can certainly speak with
a certain degree of authority about this and the importance of doing procedures that are
safe and predictable.
So I think it’s important to have this discussion.
I think that if you’re putting it upon yourself to ensure that your doctor does what is right,
I think it really is a function of your understanding of the doctor’s perspective and the doctor
understanding your desired outcome so that when you go into the operating room, you go
in with a complete trust in the doctor you choose to do this so that you don't have to
micromanage your process and worry about whether or not you got what you were supposed to get
after surgery.
So I hope that was helpful, I wish you the best of luck and thank you for your question.