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I'm a 29 year old female with what I think are bags and dark circles under my eyes. But
having done some research, I think the appearance of bags might be hollowness. I'm considering
a filler or lower lid surgery and seeking advice on which would be best for my case.
Thank you for your question!
At the age of 29, you are aware of puffiness under your eyes and you're asking a question
of whether or not to reduce the puffiness or do some kind of filler to hide the puffiness.
Well, a few years ago, once fillers became more and more popular, there has been a lot
of misinformation about what fillers can do about under eye bags. And certainly, a lot
of it is propagated by non-surgical physicians. So, as what they say, to the matter of the
hammer, the world is a great big nail. For those who cannot do lower eyelid surgery,
they advocate filler and avoiding the knife. So let's just get a sense and perspective
of some anatomy and what's relevant for your facial features and what would be the way
I would handle someone like yourself who comes to my practice.
I've been practicing for 20 years, specializing in oculoplastic facial reconstructive plastic
surgery, and so there are some things to understand. First of all, we have to look at anatomy.
What is going on with your lower eyelids? Well, these lower eyelids, these fat pockets
called lower eyelid fat prolapse pushes forward. It's a hernia. So if you think about a hernia,
you think that this is not a place where the fat is supposed to be. It's supposed to be
back.
So what the argument for filler is let's just add volume to meet where the hernia is. That's
not actually practical because you need a lot of filler and you could take, for someone
like yourself who has a naturally think face, and it can make it look very blown-up.
In our practice, in the upper east side of Manhattan and in Garden City Long Island,
we see a lot of patients who put way too much filler in their face. And unfortunately, we
have to do things very often to dissolve that filler with a material called hyaluronidase.
In terms of the benefit of filler to the face, I'm not going to say that you would benefit
but as far as the bags are concerned, my recommendation, based on what I do for most of my patients
who are in your age range is a procedure called transconjunctival blepharoplasty. Now, what
that means is that I go from behind the eyelid, I get to the fat pockets and I sculpt and
change them so that the contour and shape of the eyelid is natural. The way I tell my
patients is, it looks like you never had bags under your eyes.
A frequent concern is about hollowing but when you look at the rest of your face, you'll
understand why people are concerned about hollowing, is that, if someone has relative
shallow cheek where the projection of the cheek is back, then they naturally can look
a little bit hollow. But, no one has looked better with the bags in place. So the first
step would be to address the lower eyelid fat prolapse.
Next, I would consider adding volume to the cheek because the over-all aesthetic of the
eyelid-cheek area, for a lot of my patients after reducing the fat pockets, is to add
volume to the cheek. Now this is something that you are not interested in and of course
none of this stuff is necessary. It's all objective. It's about what you feel is necessary.
What I would recommend is avoiding the challenge of trying to have the benefit of surgery without
doing surgery by adding volume in a way that, unfortunately, make a lot of people amorphous
and strange and I think that's one of the reasons why we see so many prominent actors
and actresses not looking natural these days.
So again, to summarize, my recommendation is find a qualified experience cosmetic surgeon
with a style with the appearance of lower eyelid surgery that you like and have the
procedure more definitively and like in our practice, we would do a lower lid transconjunctival
blepharoplasty combined with platelet-rich plasma and other ways to improve skin quality.
And then you can re-assess. Once you take away the big negative on your facial feature,
a dominant facial feature, then seeing how you look and seeing you that you want to add
volume, it become a lot easier and becomes a lot more straightforward.
So I hope that was helpful for you and thank you for your question!