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Is my lower eyelid / cheekbone puffiness to difficult to get rid of with lower eyelid
Blepharoplasty?
I have puffy lower eye lids/ puffiness around cheekbones. The bags look like there's fluid
or fat that hangs over and stops at the cheek bone. I would love to have a smooth non-puffy
look around the cheekbone area. I would like to get lower lid blepharoplasty. Is my case
too difficult to treat since the puffiness falls in and around my cheekbone area? What
should I do? I am prone to scarring. Would my lower eyelids keloid or scar badly?
Thank you for your question!
You've submitted a question where you are asking that the area over you cheekbones is
too difficult to treat with blepharoplasty. You submitted some very good photos that demonstrate
this area. Well, certainly the question is a very valid question. This area has been
an area of frustration for anyone doing surgery in the eyelid and face area.
We refer to this chronic elevation in the cheek area to as malar edema or malar festoons.
Now you don't have festoons because they are like bags that hang over but that type of
swelling is unfortunately the type of swelling that is difficult to address surgically. Many
methods have been tried over the years. I have been practicing facial plastic surgeon
for 20 years and I have seen presentation of everything from CO2 laser, to cauterization
under the skin and unfortunately, a lot of methods can worsen the problem.
Let's understand a little bit of what the issue is. This area is edema or swelling and
if swelling, there's fluid then it's within the tissue. It's not like there's a bag of
fluid that you can stick a needle and aspirate out the fluid. When I see a patient with this,
I ask some basic question about what the possible causing factors could be. Typically, malar
swelling can be associated with smoking, allergies, sinus problems and genetics. On that list,
there are things that you can address. If you are a smoker, do your best to stop. If
allergies, manage your allergies. If sinus issues, manage the sinuses. If it's a genetic
factor, you are not likely to get benefit from a surgical procedure.
There are selected patients where we try different things to try to do shift the focus away from
those lines by a strategic use of various fillers. We even use platelet-rich plasma
which has some variable improvement because the platelet-rich plasma which is drawn from
your own blood has vascular growth factors and so we improve the circulation to the skin
in that area. Ultimately, it is a matter of to improve the appearance but not the definitively
remove this area. We are all constantly looking for solutions for this but if any of the previously
mentioned risk factors are things you do have, then you can treat then by all means, address
that. Until then, I would advice avoiding surgery and meeting with some doctors and
getting some opinions. The thing that we can't do with photo alone is a 3-dimensional appreciation
of the volume and projection of this area as well as how it impacts on you. On a photograph
and your eyes are very different. So when you see a person with this type of situation,
it's easier to make a good assessment of the situation. So I hope that was helpful and
thank you for your question!