How to Treat Eye Bags and Dark Circles without Scarring, and Preserving Eye Health

Thank you for the question. You submitted a photo and you state in your
question that you’re 59-years-old and you’ve been dealing with under eye bags and dark
circles for quite some time. You’re asking is blepharoplasty the best
option for you or are there alternatives. Well certainly, based on just the photos alone,
I can give you my opinion about how I approach patients like yourself in my own practice. A little bit of background, 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 and certainly this is a problem that we deal with every day and
as an oculofacial plastic and reconstructive surgeon, I can also give you some guidance
as to the importance of the right approach to your issue in terms of your eye health
which is very important. So to begin with, let’s start with first
diagnosing or at least, my impression of what I see when you describe the under eye bags. The reason for those under eye bags is something
called lower eyelid fat prolapse. Lower eyelid fat prolapse means that the fat
pockets that are normally around the eyes pushes forward, herniates, creates these bulges. MRI studies have actually shown that in a
lot of people, these fat pockets actually increase in size and volume resulting in these
bulges. So it is not just that it pushes forward and
because of weakness in the tissue which is often associated with aging but also there
is often the increase in volume. Now in addition, as people get older, there
are also important elements that have to be addressed when you are considering something
to do for this problem and that includes the integrity of the support structure of the
lower eyelid. One of the things about cosmetic eyelid surgery
is that it is sometimes oversimplified by a lot of my colleagues and when, unfortunately,
when they perform this type of surgery, patients will have problems such as lower eyelid retraction
or the eyelid is pulled down or ectropion or the eyelid is everted out and it has to
do a lot with the integrity of the support structures. And this is where being an oculoplastic surgeon,
I look for these things and I actually make a point to address them at the time of surgery
to prevent these types of problems. So in terms of my general approach to a situation
like yours, well to begin with, when I evaluate a person who has similar issues, I make sure
that I look at their dry eye history whether or not they are on artificial tears, whether
they have any issues with that. That also is a factor on how the surgery is
performed. I look at the integrity of the muscle that
supports the eyelid, the integrity of the tendon that supports the eyelid and then I
discuss basically the 2 basic different approaches in addressing the fat pockets. When we talk about blepharoplasty of the lower
eyelids, there are two approaches: one is the transcutaneous approach which is more
commonly performed by, I would say, the majority of general plastic surgeons and that is where
the incision is made in the outside and the transconjunctival approach which is done from
the inside. Now in my experience and my personal style,
I generally prefer to do, even if people are a little bit older, is something called a
transconjunctival blepharoplasty where I address the fat pockets but I maintain the integrity
of the skin and muscle and support structures. If the tendon needs to be reinforced, there
are other procedures that are done in addition to that but I like to keep that front part
of the eyelid stable because the muscle under the eyelid called the orbicularis oculi muscle
is like a hammock and it holds things in place. And a lot of times, well meaning colleagues
will actually make an incision in the outside, separate these layers and then trim off some
skin and it ends up causing the eyelid to evert or in doing the procedure this way,
there is a loss of structural integrity of the lower eyelid and that results in requiring
additional surgery. When people ask me, “What about these wrinkles
under the eyes?”, I try to explain that there is a difference between relative quantity
of skin and relative quality of the skin. And typically, I have found that we can address,
there is very rarely a time where there is a true excess of skin and usually it is more
of the quality of the skin. So how do we address the quality? We address it with using platelet-rich plasma
(PRP) which is derived from your own blood to stimulate your body’s collagen and basically
deal with the loss and thinning of the skin with age as well as the use of lasers such
as Fractional CO2 laser, fractional Erbium laser or ablative of either type of lasers
but basically to improve the skin quality and improve the wrinkling. The goal is not to create porcelain smoothness
but to improve the appearance, improve the discoloration and the dark circles. Overwhelming majority of the time, people
have an improvement and they want to further enhance the eye and cheek area, this is where
we talk about fillers and ongoing treatments whether it’s platelet-rich plasma (PRP)
and other things but a lot of times, once people have their bags done, they are very
happy not to have bags anymore and so they may come in for other things. Botox® and other complementary procedures
always has a role in maximizing the aesthetics of this area but certainly from my perspective,
the critical decision is the type of surgery being performed and the way to preserve the
integrity of the eye and the eye health. So meet with qualified, experienced cosmetic
surgeons and understand these issues before moving forward and go with who you feel comfortable
with but I think you will find that this could be a very nice and gratifying procedure. Having getting rid of bags under the eyes,
I feel it’s almost like doing a facelift. It really brightens up the entire face. So I hope that was helpful, I wish you the
best of luck and thank you for your question.


  1. if I do my Skype consultation will the money deduct from my total even if I scheduled for months down the line

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