I have bags and wrinkles under my eyes. Can this be fixed?
I need to know can this be fixed or improved? It's all I see when I look at myself!
Thank you for your question!
You submitted two photos that appear to be taken from inside your car or at least in
a place where you’re slightly looking down and you’re expressing concern about the
bags under the eyes and wrinkles. And you state that it’s all that you see. So I’ll
share with you how we approach patients like yourself in our practice.
I’m a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for
over 20 years. This means, if you’re not familiar with the specialty, is that my background
training was first in eye surgery and specialized training specifically in eyelid cosmetic and
reconstructive surgery and surgery as well as on the face and the bones around the eyes.
So rejuvenating is something we do every day in our practice. In approaching the concerns
that you have in the under eye area will define how we approach this when patients come to
us.
There are typically two major issues: one is puffiness and two is wrinkling. So puffiness
under the eyes is typically related to fat pockets. These are fat pockets that have nothing
to do with body fat but rather the genetics with the anatomy around the eyes. What happens
is when you have under eye bags. That fat pockets actually push forward and they prolapse
and they result in a bulge. This bulge of fat, once it happens, it can’t be pushed
back and people often try all kinds of over-the-counter creams and concoctions and they generally
fail to do anything. As a basic rule of thumb, treatments that are over-the-counter have
a limit of how deep they can penetrate no matter how much the manufacturer promote and
advertise and have all of this great marketing, you just can’t go far into the skin to be
able to reduce the volume of the fat pockets.
So what we do in our specialty is address this fat pockets in a procedure called lower
eyelid blepharoplasty. This means that fat pocket can be approached surgically. Now surgery
is often a scary options because people think of hospitals and deep anesthesia. But in our
practice, we have our facilities that are certified by The Joint Commission. These are
the same people who certify hospitals to make sure office-based cosmetic surgery is performed
at a very high level equivalent to an ambulatory surgery center or hospital in terms of our
safety protocols and methods of sterilization and etc.
We do these procedures typically under local anesthesia with LITE™ IV sedation. This
means you are given an intravenous or an IV and you’re given something equivalent of
a liquid valium that relaxes you and allows me to do the procedure. Our patients recover
very quickly typically in one week in terms of going back to work and the methods of surgery
depend on whether or not there’s the presence or absence of excess skin.
There are two approaches to the lower eyelids: one is called the transcutaneous approach
or from the outside and the other is from the inside called transconjunctival approach.
In order to determine which approach is best for you, requires a physical examination to
determine whether or not there’s excess skin. in my practice, my more popular procedure
is a transconjunctival blepharoplasty. That means I am able to avoid an external incision
and usually, people don’t have extra skin.
Ironically, even if they feel that they have extra skin because of the appearance of wrinkles.
Wrinkles under the eyes are actually due more to skin quality changes rather than to skin
quantity. When we’re taking about skin quality, we’re basically talking about loss of collagen,
loos of blood supply, loss of the youthful elasticity of the skin.
When we approach lower eyelid skin, we employ a technology of regenerative medicine called
platelet-rich plasma. Platelet-rich plasma is a concentration of the growth factors and
healing factors necessary for wound healing, drawn from your own blood which is done like
a routine blood draw that you would when go for routine labs. We’re able to stimulate
new collagen, stimulate new blood supply and improve the quality and color of the skin.
In a lighter skin individual, we also employ a technology called fractional CO2 laser.
This is a very precise way to direct thermal energy to the skin in a way that causes skin
contraction, improvement of fine lines and wrinkles. We can’t make people like they’re
25 again but we can certainly build up the collagen and improve the appearance. So this
dual approach is very typical in our practice.
I would also mention to you that when people look at themselves and focus under the eyes,
the under eye bags, they also sometimes miss that they have hooding over their eyelids
and I would respectfully mention to you that this is also present and maybe something that
you want to address at the time of your consultation.
I would recommend that you meet with qualified experienced cosmetic surgeons, learn about
their style by looking at before and after pictures, learn about the type of sedation
or anesthesia and of course, you have to be comfortable with the doctor. I think it’s
critically important that you are able to communicate your concerns and set expectations
of what you would like to see occur once the procedure is completed.
So I hope that was helpful, I wish you the best of luck and thank you for your question!