Are eye bags and fat deposits the same thing?
Are eye bags and fat deposits the same thing? I’ve seen 3 doctors. First doctor says it’s
fat deposits and I need lower eye lid surgery. Second doctor tells me eyelid surgery is no
good because later on I will have a hollow look. Third doctor tells me I am a good candidate
for Radiesse. I have no IDEA what to do. Every surgeon had a different solution. I prefer
not to have eyelid surgery. If eyelid surgery is my solution, then l definitely go with
that. Don't want to spend that kind of money if it's not necessary.
Thank you for your question!
You’re asking about eye bags and fat deposits are the same thing and you have experienced
going to three doctors for the under eye bags and getting three different opinions. So let’s
just get down to the basic anatomy issues and also an understanding of the some of the
conflicting recommendation you are getting.
So looking at your photos, without these other opinions from colleagues, it’s very straightforward
that you have something called lower eyelid fat prolapse. Lower eyelid fat prolapse means
that the fat pockets normally around your eyes push forward. On MRI studies, it actually
showed that there is an increase in volume and become hernias. We refer to it as herniated
fat. So this fat is pushing forward and creating these bags under the eyes.
Now as far as solutions are concerned, the concerns about how to do this and what the
consequences are is becoming more confusing these days because there is certainly a lot
of options being suggested by different doctors as treatments for under eye bags. There are
people like myself who tend to advocate more definitive solutions like surgery. In a case
like yours, we would typically do something called a transconjunctival blepharoplasty.
This is a technique where we work at the fat pockets from the inside of the eyelids, performed
under local anesthesia with LITE™ sedation and essentially reduce and reposition as is
appropriate so it looks like you never had the fat pockets there. Now that’s a good
way of starting because it’s addressing the true anatomic issue.
So the concern about hollowing becomes an issue. Well, hollowing is very often perceived
when someone’s eyelids are pulled downward and that is really what scares a lot of people.
What the situation is called is lower eyelid retraction. We have a lot of experience in
our practice because as specialist in this area, I see a lot of patients from all over
the world to correct lower eyelid retraction and to help them look as if they are not as
hollowed.
You see, when you do a standard lower eyelid surgery, it’s not the generic procedure.
There are many different methods. There’s an external approach called a transcutaneous
approach. There’s an internal approach called transconjunctival approach and there are different
things that you can do in terms of the support structures of the lower eyelid and this makes
it challenging for people to find the right doctor to help them with this problem because
there are a lot of people offering their version of the solution. I think you have less to
worry in terms of the hollowing in that area.
Something that does happen with facial aging is volume loss in the cheek area. So a lot
of times, when we do out consultations, we point out to our patients that you may be
focused on the bags but you have to notice that below the bags, a cheek is very flat.
And so sometimes people think: “Why don’t I look much better?” They look better but
they feel like they can look so much energetic and it’s because they’ve lost volume in
their cheek.
So there’s a solution for that and options such as Radiesse that you referred to in the
third doctor. And the point is that whether it’s Radiesse, Restylane, fat or any other
cheek implants, you can do something to improve the volume of the cheek. But I would respectfully
disagree that you would put so much volume to camouflage the fat pockets that pushing
forward or herniated forward. It’s way too much. We have patients who come to us all
the time who got over puffed and they look unrecognizable. And we end up using ways such
as for hyaluronic acid filler, we’ll use an enzyme like hyaluronidase to actually dissolve
the fillers so that they actually look like themselves. And you see, they do have pockets
under here and we see why they got so much filler but very often, it just looks too unnatural
when it’s overdone. It can be done beautifully and subtlety in the right candidate. But when
it is done in excess, it looks like someone has an allergic reaction.
So, from my perspective, a lower eyelid blepharoplasty performed in a way with an understanding of
the outcome, that is about communication, will probably be the best direction for you
because no matter what, the puffy bags are a very dominant feature on the face. And no
matter what you do to the rest of the face, the bags under the eyes are there, everybody
thinks you’re tired and you’re sad. So with that being said, I think you need to
try to narrow your decision and try to figure out what the 3 doctors that you met who’s
recommending the surgical options, kind of resonates with you and you feel comfortable.
Otherwise, meet with the additional doctors and I think that from my perspective as an
experienced 20-year cosmetic oculofacial plastic surgeon practice that transconjunctival blepharoplasty
most likely would be starting for you to at least address the dominant feature on your
face.
So I hope that was helpful, I wish you the best of luck and thank you for your question!