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Surgery or Restylane for 35 yo?
I am interested in improving the appearance of my under eye area. In my case, would you
recommend Restylane injections or would surgery be necessary? What would be the recommended
procedure? I am 35. Is it likely that the Restylane option might worsen the appearance
of my eyes in the long run, after its effect wears off?
Thank you for your question!
The age of 35, you have submitted this single photo where you're asking whether to do surgery
or to use Restylane. And then you're asking whether or not Restylane can affect the appearance
long-term. So certainly, you have a very legitimate question. In the modern world, there are certainly
more than few options to consider when it comes to hollowing and puffiness under the
eyes. So before we define the solution, let's define the problem.
At the age of 35, with the photo you submitted, it appears that you have very thin face and
there's a combination of a slight bulge of puffiness under the eyes that represent something
called lower eyelid fat prolapse. Lower eyelid fat prolapse is the fat around the eye kind
of herniating forward and pushes forward slightly to the point where it looks puffy.
Now paradoxically, adjacent to the puffiness is a relative hollow and there are two areas
where the hollow is manifested. One is the tear trough area. That's the area just adjacent
to the puffy area. And below the tear trough area is called the eyelid to cheek area sometimes
referred to the V deformity. Now this is when the bone around the eye called the orbit.
It previously had a little bit of fat over there and the fat diminished and it's thinner
so you see more of the bone structure. Now if you're already a very thin person, this
is something that tends to happen then you get this overall hollowing appearance.
So you have a couple of options. And one of the things that I do is that I explain to
my patients of how they would look when we address the puffiness under their eyes. But
understanding that the overall appearance of their eyes may require more than just the
reduction of the puffiness. We would often combine the surgical procedure with platelet-rich
plasma as well as restylane and fillers at the time of the surgery or later on.
Now when people are at the threshold and I think you fall in that category although I
can't see a side view of your eyes, when there's only a slight puffiness, we can always do
a trial where we strategically place some restylane, a hyaluronic acid filler. I often
combine it with platelet-rich plasma and I find that the benefits of blood supply improvement
as well as quality of the skin act synergistically with the volume benefits of hyaluronic acid.
I think it's reasonable to do a trial in using this filler if it's done well and see if you
like the look. And if you like that look then this something you can maintain by doing this
once or twice a year depending on how your body metabolizes the filler. Now if the filler
does not help adequately enough then surgical procedures may be the next step. Again, it's
all about communication and understanding what would be the results afterwards.
I typically address the eyelid-cheek area. As a facial cosmetic surgeon who performs
face lifting, cheek implants, facial rejuvenation surgeries routinely, I look at the eyes and
their context to the whole face. Very often, it's a strategy about balance of doing not
only the focal area of the eye but also to enhance the volume of the cheek. Now it doesn't
mean you want to look like a pillow or overdone but I always make a distinction between correction
versus augmentation. When we talk about volume loss and aging, we're talking about correction.
So I think at this point, the best thing for you is to meet with a qualified and experienced
cosmetic surgeons who focus a lot on the eye area and see who you resonate with and start
exploring these options. I think the very safe option is to do the injectables first
step. The nice thing about hyaluronic acid is that there's an enzyme called hyaluronidase
to dissolve the material if it turns out to be in excess that causes more puffiness. But
it's a good first step and I'm making this recommendation based on that single photo.
So a 3-dimensional examination certainly has considerable advantages than reviewing a single
photo. So I hope that was helpful, I wish you the best of luck and thank you for your
question!