Thank you for your question. You submitted a single photo with your eyes looking upward, asking how much it costs for eyelid surgery, or if your eyelids can be treated with just an injection.
I can share with you my initial impression with this limited photo, and what I believe you’re drawing attention to. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years, and helping people with the under eye and cheek area is something I do every day in my practice.
I suspect you are trying to draw attention to the under eye area and the puffiness pushing forward, which is expressed more when you look up. From that respect, we should identify the anatomy causing this. What you are looking at are fat pockets referred to as lower eyelid fat prolapse, meaning fat pockets normally around your eyes pushed forward to create these bulges. This is a very common issue with facial aging, and also typically genetic form, so it tends to run in families. I have operated on the same family in 3 generations, so it’s very common.
The question of whether to do surgery or injection, if we’re dealing with facial aging as an overall issue, chances are you would be a candidate for both. If you have under eye puffiness, and want to see if you can hide it a little better with an injection, that is possible, but it may not be optimal. The principle behind using filler to help with the appearance of under eye bags is the placement of filler in an area called the tear trough and the lower part of the eye socket, which we refer to as the V deformity. Placing filler in this area can sometimes soften that transition between the lower eyelid fat prolapse and the area adjacent because the puffiness can make the hollow look deeper.
In many patients, there’s a combination benefit if they do the surgery and filler at the same time, but not necessarily in the same area. One of the things we have to understand with facial aging is people always understand wrinkles and sagging, but something not understood is volume loss, not just from skin and fat, but also bone. This is very important because one of the things we do in our practice is something called structural volumizing, which uses long-lasting fillers such as Juvederm Ultra Plus or Juvederm Voluma placed on the bone structure around the cheek and under eye area. This restores some of the lost volume from the receding bone structure. One can argue that the puffiness under the eyes is further accentuated by this recession of the bone structure, and the further widening of the eye socket. This is difficult for a lot of people to grasp, but the solutions revolve around this strategy.
When I evaluate someone like yourself, I take photos from multiple angles, and place them on the screen so we go over the different angles to show what are fat pockets and prolapse, just to be complete about the options besides fillers. We do something called lower eyelid transconjunctival blepharoplasty which is a surgical procedure where I approach the fat pockets from the inside of the eyelid. This is an extremely effective procedure because the shape of the eye is maintained, and the main issue of fat pockets pushed forward and creating puffiness is addressed with minimal trauma - we’re reducing, shaping, and repositioning the fat. On top of that, we often do a combination of platelet-rich plasma (PRP) which is derived from your own blood to stimulate the collagen and improve skin quality to address some of the facial aging and environmental skin issues. We often combine an energy-based device like a radiofrequency such as Pelleve for darker skin types, or a laser such as fractional CO2 laser or Erbium laser for lighter skin types -everything is always customized. On top of that, structural volumizing for the cheekbones can also be beneficial.
I think it’s important you meet with qualified, experienced cosmetic surgeons to learn about your options, and about what makes sense to you. You have to think about the outcome you want, and what procedures will get you there. You may want to do everything at one, or take it in small steps. In our practice, my patients have been with me for years, so we look at things from a long view rather than just a single procedural outcome. We have so many options these days, a lot of ways to solve issues, a lot of strategies that can be optimized and customized to your needs. I think it’s very important you just get that flavor by meeting with doctors and seeing what you’re comfortable with. Everyone has their own style, so it’s important your personal style and your doctor’s style really are in sync. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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