What is the cause of the fat pad under my eye, and how can it be treated? (Photo)

The best approach for many is to do this surgery from behind the eyelid.  This avoids a skin incision.  The fat sitting in the lower eyelid is advanced into the top of the cheek.  This reduced the volume in the lower eyelid and improves the hollow at the top of the cheek.  Surgery is very comfortable and is generally performed under light iv sedation on an outpatient basis.  There is no substitute for a personal consultation.

I’m a cosmetic oculofacial plastic surgeon, board-certified by the
American Board of Cosmetic Surgery. I’ve been practicing in Manhattan and Long
Island for the past 20 years and under eye bags is one of the most common
issues we treat in our practice.



Your eye bags are caused by lower eyelid fat prolapse. This means that
the fat that is normally around your eyes pushed forward and creates a hernia.
Once the fat pockets have pushed out, it pushes out even further as time goes
on. There are numerous factors that can contribute to it getting worse but the
fact that you have a significant asymmetry clearly draws a lot of attention and
people asking you if you are tired.



When you look for solutions for under eye bags, it’s likely that you’ve
already tried the topical creams and moisturizers that are typically sold and
of course, those don’t work. When you’re dealing with a physical volume of fat,
nothing topical will make a difference. There are also options using various
types of hyaluronic acid fillers to camouflage the fat. This is unfortunately not
likely a benefit for you. In the absence of a physical exam, it seems pretty
obvious from your photo that the bag is too prolapsed out to hide it or
camouflage with a hyaluronic acid filler.



In our practice, for someone who’s young, we typically address this
problem through a procedure called a lower eyelid transconjunctival
blepharoplasty. The reason why I use the term transconjunctival has to do with
the approach. There are two ways to address fat pockets: from the outside
called transcutaneous approach, and from the inside called the
transconjunctival approach. For younger people, usually there is no issue with
extra skin and therefore there is no reason from my perspective to go and make
an incision on the outside. What we do is we address the fat pockets from the inside
of the eyelids so there is no external scar.



We also perform these procedures in our office facilities under local
anesthesia with LITE™ sedation so you avoid general anesthesia. A lot of
surgeons prefer general anesthesia. I have been doing this procedure for over
20 years and I have a lot of experience with it. I find that the experience of
the patient is better when they avoid general anesthesia, and are able to
recover a lot faster without the side effects of the medications. By avoiding
all the stress of general anesthesia by using local anesthesia with sedation, most
of our patients go back to work in less than a week.



I recommend that you meet with qualified, experienced cosmetic surgeons
and learn about the options. Get to know your doctor and get a sense of what
that doctor’s aesthetic and style are. Get a sense of what you can anticipate
your final appearance will be. What I explain to my patients is that when you
have this procedure done, because you had puffiness for so long, it’s hard to
imagine yourself without the puffiness and there’s a common concern of being
over hollow. Our goal is to achieve a look as if you never had the bags. This
means that the skin will naturally follow the contours as if there was no fat
prolapse there. I hope that was helpful, I wish you the best of luck, and thank
you for your question.



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