What would the most effective under eye treatment: surgical, non-surgical and non-invasive? (photo)
Doctor Answers 7
Fillers can camouflage mild eye bags, but yours are bigger and require surgery, but no trace of surgery will be visible
Currently, there is an alternative for a limited amount of puffiness where we can use a filler to try to camouflage it. Unfortunately, for your situation, the puffiness is significant enough that you would need to undergo a surgical procedure. Being someone in your 20s, most likely that procedure would be a transconjunctival blepharoplasty where the fat pockets are addressed from the inside of the eyelids. By doing that, there is no external incision. We do this procedure under local anesthesia with LITE™ sedation for faster healing and recovery, in contrast with a lot of surgeons who prefer to do their procedures under general anesthesia. I’ve always been an advocate for quick recovery and natural results and this procedure is actually in some ways comparable to a less invasive or non-invasive procedure. I would even argue that the majority of our lower eyelid blepharoplasty patients look better than a lot of people who get injectables under their eyes who have big bruises that last for weeks.
We have also been able to evolve our treatment for puffiness under the eyes with a strategy that helps skin quality. Skin quality under the eyes, the fine lines, wrinkles and the hollowness have always been a challenge and the typical treatment would be a laser treatment. We have mircofractional CO2 laser and I have been using it more strategically in balance with another method that we do to help skin quality using platelet-rich plasma. Platelet-rich plasma is your own blood that is drawn like a regular blood draw for a blood test, then spun down to concentrate the platelets which have the healing and growth factors. These factors improve the vascularity, the backbone of the skin and collagen production. I have been very impressed when we combine platelet-rich plasma with our blepharoplasty procedures on how good the patients look. So we would do lower eyelid blepharoplasty with platelet-rich plasma concurrently to help with the skin quality.
After all of this is resolved, you would then decide if you want to add any volume in any area that would be strategic. A hyaluronic acid filler like Restylane and Juvederm would be used. However, we do it a little bit differently - we would combine it with platelet-rich plasma because we have observed a synergistic benefit. There’s more volume correction and more natural tissue growth that is better than either component of PRP or hyaluronic acid on its own.
At this point, it’s best if you do some research and find qualified experienced cosmetic surgeons who you feel comfortable with. Have a consultation, get to know them and move forward with your solution. Since you have a wedding planned, the sooner you do this, the better. I hope that was helpful, I wish you the best of luck, and thank you for your question!
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Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservatively removing any excess loose skin that may be present, contouring the bulging fat pads, which are generally inherited, unrelated to weight, and tend to protrude more with time, and smoothing the tear troughs with micro-fat grafts or fat repositioning.
Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you exactly what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of each operative procedure would not be in your best surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, M.D., FACS
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The answer very much depends on your physical examination.
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