Thank you for your question.
You submitted several photos with your question.
You stated in your question that you had some Restylane placed under your eyes to help improve
the appearance of not looking tired with the desire to look less tired.
And you are aware that you still need lower eyelid surgery.
So you’re asking, what’s the time frame.
Do you have to wait before having surgery.
I can certainly help you understand my strategy when I deal with patients like yourself in
my practice which I do a fair amount.
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 under eye bag surgery has been the foundation in many ways of the practice and it’s a
procedure we essentially do every day.
And we help patients who come to us from around the world with this issue as well as many
other complicated issues.
So to understand the philosophy, you have to understand a little bit about the anatomy
and the placement of these fillers.
When fillers became introduced as a way to help people look better who have under eye
bags, it became clear to me and ultimately proved to be true that a lot of people with
very prominent under eye bags were going to get fillers but still not be satisfied with
the full correction in terms of the outcome.
Essentially, with the under eye puffiness, if someone has a mild amount, a minimal amount,
you can get a very nice result to camouflage the under eye area with fillers.
But once it’s beyond a certain amount, you can actually slightly improve or you can actually
make it look worse.
So when patients like yourself come to my practice, I first guide them as to what’s
the explanation for the under eye bags.
So the under eye bags are referred to technically as lower eyelid fat prolapse.
This means that the fat that’s around the eyes pushes forward and creates this bulge
and it’s mostly a genetic issue, can be aggravated certainly or can become more advanced
with smoking, allergies, sinuses as well as normal facial aging.
The approach that we typically do for someone like yourself is I do a procedure called a
transconjunctival blepharoplasty.
This means addressing those fat pockets from the inside of the eyelid and this way, avoiding
an external incision and going directly to the fat pockets and doing what’s appropriate
to sculpt them in a way so that it looks like you never had the under eye bags.
So the question arises, how do we differentiate the volume that’s from the filler from the
volume that’s from the fat?
I would say in a physical examination, when we have the patient look up and look at different
directions, we can see the fat volume actually push forward.
Now if there is filler that is maybe obscuring the full clarity of this, I actually don’t
wait for the filler to go away.
I can actually dissolve the filler with hyaluronidase which is an enzyme that dissolves the filler.
Now that doesn’t necessarily mean that there’s no role for filler in the future.
So it’s a very important caveat.
The reason is when we think about facial aging and cosmetic procedures, often when the under
eye bag is the dominant issue, then patients always focus only on that under eye bag.
But what I bring to their attention is that concurrently, they can have issues with volume
loss in the cheek area, they can have volume loss directly below the orbital rim as well
as in the tear trough area.
So I explain that after we take away the big negative of the under eye bags, you may still
need fillers.
So it’s not like we have just one procedure to solve everything for the rest of your life
but rather to understand that there’s a strategy of addressing what is the dominant
issue and in your case, the under eye bag.
So to summarize, essentially, after physical examination, if I would not be able to tell
or at least help you see what your before and after would be because you can’t really
tell what‘s fat or where does the fat begin and where does the Restylane begin and where
the transitions are, then it’s very straightforward to just dissolve the material and I’ve done
that for many patients.
Because a lot of times, they come in with under eye bags and when they got a filler,
they ended up looking even more puffy.
And so, I have had patients where we had to do a couple of rounds of hyaluronidase before
we actually saw their true anatomy.
I’m not saying that’s the case for you but I think that you don’t have to necessarily
wait if you would like to address this sooner rather than later.
Now as far as if you wanted to choose to wait, I think it’s fairly well understood, at
least from my experience, that the timeframe for Restylane to be metabolized in the under
eye area really varies.
It can be as little as a few months to as long as several years.
So I think that since, if you’re looking for a more definitive procedure, have the
consultation with a specialist, someone like an oculofacial plastic and reconstructive
surgeon.
So he understands the eyelids very well, who understands how to do the transconjunctival
approach and helps you understand the difference between the under eye bags and the Restylane
and then you make an informed decision.
You can wait or you can move forward and have the material dissolve or do it without having
the material dissolved.
That’s also an option.
Sometimes, people feel that the filler that they had like 2 years ago may still be present
but when I examine them, I see no evidence and so I tell them that there’s no filler.
We can go ahead and proceed and from that point, we go forward with the surgery.
I think that, again, based on that again, move forward with meeting with qualified,
experienced doctors who perform these types of procedures, cosmetic surgeons, oculofacial
plastic reconstructive surgeons and hopefully, you’ll be able to achieve a nicer aesthetic
appearance for your eyes.
So I hope that was helpful, I wish you the best of luck and thank you for your question.