As a cosmetic oculofacial plastic surgeon, I deal with many patients who have an allergic conjunctivitis history. The first thing I recommend before considering any surgical procedure is the management of the allergies because allergic conjunctivitis will cause swelling and puffiness to the eye area even with the reduction of fat. If there’s puffiness that’s related to fat prolapse, which is fat that’s normally behind the eye pushing forward also called fat herniation, then that can be addressed surgically. However, if the goal is to reduce puffy bags from the eyes, then we should try to manage it from all angles. So meet with your doctor whether it’s your ophthalmologist or allergist to get on the right regimen of antihistamines, eye drops and even nasal sprays if there’s a rhinitis component to this and try to get that under control.
After the allergies are under control, and you still have bulging of fat that’s pushing forward, the most common procedure that I recommend for someone who’s young, dark skinned and who has fat prolapse is transconjunctival blepharoplasty. This procedure is the reduction and sculpting of fat from the inside of the eyelid, so there’s no scar on the outside. When you’re young and you have dark skin, you’re likely to show an incision even if it’s done finely and beautifully, and we want to avoid it. So, I perform transconjunctival blepharoplasty routinely in my younger patients with darker skin types to assist them in reducing the area of puffiness.
After eyelid surgery, I encourage my patients to still manage their allergies because seasonal allergies and other things can still affect the final aesthetic result of the eyelid surgery. The surgery can correct the fat prolapse but the management of the allergies is also critically important for the long-term aesthetic of the eyes.