I have hereditary under eye bags. I inherited them from my grandmother. I've had them my
whole life. Any advice?
My bags are puffy and dark but the puffiness is what bothers me most. I look tired when
I'm not tired. What type of blepharoplasty is recommended at my age? I doubt fat transfer
is the answer for me.
Thank you for your question!
You stated in your question that you have hereditary eye bags that you got from your
grandmother and you wanted to know what type of blepharoplasty is best for you and you
also made a comment about fat transfer probably not being right for you. So, I think that
the photos you submitted are extremely helpful and clearly they demonstrate significant under
eye bags.
So, I’m an oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years
and addressing under eye bags is pretty much what I do every day. And I’ll tell you a
little bit about first what the situation is anatomically for you and how we approach
someone like yourself when you come to our office. So why do you have bags under your
eyes? Well, you’re right. Genetics is a very big factor and has to do with the anatomic
structure of the septum or the sheet that separates the front of the eye to the back
of the eye and the fat behind the septum. And so when fat pushes forward, it’s referred
to as herniated fat. So these are like fat pockets that have pushed forward and have
gone over to the point where they’re just sitting there and no matter what you do and
lot of patients come to us after trying creams and teabags and all kinds of different things
and find that none of them work. What you are dealing with is an anatomic issue.
So that brings us to the topic about the surgical procedure that’s best appropriate for you.
Now, there are two ways to address the fat pockets. One from the outside called the transcutaneous
blepharoplasty and one from the inside called the transconjunctival blepharoplasty. Someone
like yourself, we would typically do a combination of things to address the different aspects
of lower eyelid rejuvenation. We’re in a very remarkable time where not only we can
address the fat pockets but we can also address the skin quality and the volume issues that
also coincide with this puffiness. So, when we take care a patient like yourself, we commonly
do a transconjunctival blepharoplasty which means addressing the fat from the inside of
the eyelids. We would combine that with platelet-rich plasma which is derived from your own blood
and it’s a concentration of the growth factors that are used for healing. By placing these
growth factors under the skin, we’re able to stimulate the skin to have more quality
and when you think about aging, loss of collagen, loss of blood supply, platelet-rich plasma
helps improve and address by generating collagen, improving the blood supply to the skin. It
adds a nice quality to the under eye area which often has a lot of shadowing and wrinkling.
Last but not least, we often use a fractional CO2 laser. There is certainly a role for a
limited amount of thermal energy to tighten and stimulate collagen from the external approach
as well as refresh the top layer of the skin. At the end, the combination, like what I like
to say that the whole is greater than the sum of its parts, turns out to be a very nice
rejuvenation of the under eye area.
Another thing that I would also like to share is that, when you address under eye bags,
it really makes a remarkable difference in a person’s appearance. They look less tired.
They look more energetic. It’s almost like doing a facelift without doing a facelift.
So I think you’re on the right track as far as pursuing a solution.
I agree with you that fat transfer is not the solution for you here. There are many
colleagues who have tried in vain to use fat to augment and restore volume. Part of the
basis of this is the fact that we lose fat and we lose volume in the cheek and in the
facial structure as we get older. Unfortunately, the skin doesn’t tolerate that much volume
and the fat can be taken by the skin at a variable way. You see, fat is a graft. You’re
taking it from one part of the body away from a blood supply, placing it in another part
of the body and anticipating a new blood supply will keep it viable. Well, the fat can be
absorbed anywhere from 30-70% and a lot of times the sequential inflammation and scarring
can create irregularities and lumps. I have patients who come to me from all over the
world who have had fat transfer and requested that I try to remove this fat. I can tell
you that it is technically very challenging and it is always more complex operating than
doing a lower eyelid blepharoplasty.
So with that being said, I recommend that you meet with some qualified experienced cosmetic
surgeons and find someone who resonated with you. In addition, be mindful of your anesthesia
options. We perform these procedures under local anesthesia with LITE™ IV sedation.
That means we don’t do general anesthesia. We perform these procedures in our own Joint
Commission approved facilities therefore we basically have the benefits of a hospital
structure and equipment, process and personnel, we have within our own office. And for our
patients, they really like that. It’s a more comfortable than going to a free standing
surgery center or something like that. So, these factors are also important: the type
of surgery, the anesthesia and the facility are things that you should learn more about
as you do your investigation.
So I hope that was helpful, I wish you the best of luck and thank you for your question!