How Excess Fat Under the Eyes Causes Eye Bags, but Losing Fat in Adjacent Areas Causes Hollowness

How Excess Fat Under the Eyes Causes Eye Bags, but Losing Fat in Adjacent Areas Causes Hollowness


What can l do for my swollen dark under eyes
hollows? Thank you for your question! You submitted a single photo which appears
taken of you looking slightly downward and you’re asking about what to do about the
under eye hollows and that swollen under eye hollows. Well, just to give you a little bit about
my background, I’m a board certified cosmetic surgeon certified by the American Board of
Cosmetic Surgery and I’m a specialist trained in oculofacial plastic surgery by The American
Society of Ophthalmic Reconstructive Surgery. That means that my background training was
first in eye surgery before I specialized in surgery of the eyelids and the areas around
the eyes and face. I’ve been in practice for over 20 years in Manhattan and Long Island.
So I can certainly tell you that we deal with your situation every day and we do a lot of
work in this area. So when I look at your photo, I think of a
couple of things when you ask this question. First is, when you look at your eyes, you
notice that there is a certain amount of puffiness under the eyes. And that puffiness or under
eye bags which may be described by you as swollen represents something called lower
eyelid fat prolapse. Lower eyelid fat prolapse essentially means that the fat that is normally
around your eyes, that’s a normal part of the anatomy, pushes forward and creates a
bulge that makes the eyes look puffy or swollen. Now, the first line of treatment for a lot
of our patients is go to the store and to buy various kinds of creams which claim to
be able to solve these under eye puffy areas with no problem but of course, they don’t
work. And the reason is that the fat that is normally around the eyes has volume and
pushes forward and it really is like a hernia and we refer to it as herniated fat. Now below the area of the herniated fat, you
can see that the eyelid to cheek area as well as the cheek area has volume loss. Now this
is consistent with normal facial aging. This is something that I wrote about in the book
a few years ago but essentially, the concept of facial aging has two elements: one is volume
loss. We lose bone, muscle and fat as we get older. In addition, there is descent or sagging.
Especially when you get to your 50s or as early as the mid-40s, depending on family
history, you can start manifesting both. So in our practice, when we meet with a patient
like yourself, we first work on with dealing with the dominant feature which is from my
perspective is the puffiness under the eyes and the approach to treating that puffiness
under the eyes. So what do we do? The essential issue is to surgically correct that puffiness.
Now when you do your research, you’ll learn about non-surgical options whether they’re
thermal devices or injectables but judging by the amount of volume you have, I don’t
think that either modality will be a value to you. What we would do probably for you is something
called transconjunctival blepharoplasty. This is a procedure where we treat the fat pockets
from behind the eyelid, we make no incision on the outside and we’ll treat the skin
quality and skin overall appearance with something called platelet-rich plasma. This is derived
from your own blood and basically leverages or uses your own body’s growth factors and
healing properties to stimulate and improve skin quality. In certain patients, we’ll
use radiofrequency while other patients, we’ll use fractional CO2 laser to improve skin texture
or resurface the top layer skin. So there’s a combined approach to try to get the maximal
aesthetics. But we also discuss a strategy on how to address the adjacent areas. The
areas where they’re not as important for you right now but they may become important
later once the big dominant factor is reduced and that’s the eyelid to cheek junction
and the cheek area. And depending on what’s your desired outcome is, there are solutions
that include improvement of volume, there are solutions that include surgical elevation
depending on how extensive you want to rejuvenate your face. So the procedure we do is also done in local
anesthesia with LITE™ sedation. I’ve been doing this for many years and we’ve developed
a very nice protocol so our patients are able to recover faster and reduce the risks of
having procedure under general anesthesia. We do the procedure in our own facility within
both of our offices which are certified by the Joint Commission which is the governing
body that’s oversees hospitals and surgery centers for implementation of certain safety
and protocols so that there’s no difference between the quality of care regardless of
the location as long as there’s a certain safety focus standards are met and that’s
of course of highest value. So with that being said, I would suggest that
you meet with experienced, qualified cosmetic surgeons. I think that as many people who
specializes in eyelids particularly cosmetic eyelid surgery, not just reconstructive but
deal with a lot of cosmetic patients because really, cosmetic surgery is its own specialty
separate from other areas. Again, it’s a matter of not just the name but what kind
of practice the doctor has. We only have so many hours in a day, we can only do so many
things so the best quality from my experience is focusing in specific specialized areas
and not doing everything. So meet with a doctor, get comfortable, look
at their before and after pictures, understand what you could expect after the procedure
and I think you’re going to be very happy. One of the most satisfying procedures we do
is to help people with under eye bags because people feel that they look tired, they look
at the mirror and they feel tired. So the phrase tired of looking tired is something
we get to hear a lot. And once it’s done, it really has a transformative effect on the
facial appearance. It’s almost like doing a facelift in the right candidate. So I hope that was helpful, I wish you the
best of luck and thank you for your question!

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