How Eye Bags and Hollow Under Eyes can Occur Simultaneously, and How they can be Treated

can I have puffy eyes and hollowness at
the same time we see a lot of people in our office concerned about puffy eye
bags and hollow under eyes while they may appear to be opposite situations
there are certain circumstances where they can exist concurrently I’ll discuss
how I assess patients with concerns like these in the eye area and how I develop
treatment solutions for them I’m Dr. Amiya Prasad I’m a
Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been in practice in Manhattan and Long Island
for over 20 years as a cosmetic oculofacial I specialized in primary
upper and lower eyelid cosmetic surgery non-surgical eyelid treatments including
the application of injectable fillers neuromodulators and lasers as well as
the correcting of complications of eyelid surgery originally performed by
other doctors helping people with puffy eye bags is something I do every day
along with treating hollow eyes and discoloration of the lower eyelids a
common concern for patients who come to me after having their under eye bags
addressed elsewhere is a perception of lacking volume under their eyes often
refer to as appearing hollow paradoxically we often see patients who
have had treatment for hollowness by another doctor and come to see me
because they find themselves with IBEX there are several different conditions
where you can have both puffy eye bags and hollowness present simultaneously
the most common of which is when the elevation of under-eye bags make the
lower eyelid look relatively hollow this is like a mountain next to a valley
in such cases people often only notice hollowness not realizing it’s the eye
bags that are making their eyes look relatively hollow in these cases
reduction and sculpting of the fat that causes the eye bags can have a
significant improvement in the patient’s perception of a hollow look when I treat
under eye bags surgically I sculpt a fat to create a
natural look with the goal of having you look like you never had eye bags I
performed his type of lower eyelid surgery using a method called
transconjunctival blepharoplasty as opposed to the more common
transcutaneous blepharoplasty during transconjunctival blepharoplasty the fat
pockets responsible for the eye bags are assessed from behind the eyelid so no
external or outside incisions are made in the lower eyelid from the way I
perform this technique my patients are able to see themselves afterwards with
the more natural appearance like they never had eye bags I also am able to
avoid common complications associated with an external incision it’s often
seen in people who have undergone the outside incision or transcutaneous
method to access the fat pockets to find that delicate lower eyelid support
structures are compromised and the eyelids become pulled down leading to a
rounded look many doctors often combine the transcutaneous method with skin
removal to try to treat wrinkles which only contributes to more rounding due to
the eyelid skin being a deficit or shortage in my practice when my patients
want to improve the appearance of wrinkles under the eyes I generally
don’t remove skin but rather I improve the eyelid skin quality with
non-surgical treatments I use platelet-rich plasma or PRP to thicken
the skin improve texture and stimulate collagen as well as using laser
treatment to prove the superficial and deeper layers
of the skin there are times when the fat pockets are so large that the underlying
hollowness in the tear trough and cheek are hidden although some doctors
advocate procedures such as fat transposition into the tear trough I
generally feel these procedures to be imprecise and minimally predictable I
counsel my patients to understand that after the under eye bags are addressed
volume enhancement of the tear trough and cheek can be performed safely and
predictably with hyaluronic acid fillers another scenario is when there is
significantly puffy eye bags and at the same time there is a lack of cheek bone
projection this is typically seen with facial aging as we age there is a
progressive loss of bone muscle and fat in the face for volume correction on the
cheekbones I approach this area a little differently than most doctors I
use a technique called Structural Volumizing where the filler is placed at
the bone level below the muscle layer when placed in the space the filler is
much more stable and provides the cheeks with solid structure and definition
creating a natural youthful appearance I use longer-lasting fillers such as
Juvederm Ultra Plus or Juvederm Voluma it’s common with more traditional filler
methods to place filler in the cheeks right under the skin for the filler to
migrate and look soft and doughy when treating puffiness under the eyes as
well as hollowing it’s important to also look at the whole face I often tell my
patients that the whole is greater than the sum of its parts
addressing puffiness and addressing areas of relative hollowness gives the
face a more balanced refreshed and youthful appearance I hope you found
this information helpful thank you for your question Oh

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