What treatment would you recommend for eye bags, lost volume in apples of cheeks after weight loss? (photos)

As a specialist in facial aging and cosmetic oculofacial plastic
surgery practicing in Manhattan and Long Island for over 20 years, I deal with
this type of problem every day in our practice. I approach this situation by
first defining the problem and discussing the different options based on the
level of long-term benefit as well as affordability.



Bags under the eyes are the result of lower eyelid
fat prolapse. Lower eyelid prolapse means that the fat that is normally around
your eyes has pushed forward and results in puffiness under the eyes. Under eye
bags or the fat around your eyes is the last fat in the body to go away when
someone loses weight. This is common in people in malnourished situations where
much of their body’s natural tissue in addition to muscle is broken down, so
losing more weight will not help in under eye fat pockets going away.



The approach to lower eyelid fat prolapse is to
perform lower eyelid blepharoplasty. This can be done in two different
approaches: one is from the outside called a transcutaneous approach and
another is from the inside called the transconjunctival approach. For most of
our patients, we perform from the inside of the eyelid called transconjunctival
blepharoplasty to avoid an external incision. The decision on the approach is
based on physical examinations. The lower
eyelids are deceptively complex and many plastic surgeons end up having the
lower eyelid pulled down or retracted and sometimes even everted. The lower
eyelid has a lot of critical important anatomic structures that need to be in
balance in order to get good results.



When we evaluate the lower eyelids, we also look at
skin quality and texture. We would consider procedures such as fractional CO2
laser as well as the use of platelet-rich plasma derived from your own blood in
order to stimulate new collagen and to improve the skin quality.



The apples of your cheeks are an area which we refer
to as the malar fat pads or the submalar space. When someone has lost volume in
this area, I also perform a lot of facial rejuvenation surgeries such as face
lifting, cheek implants, etc. I try to decide how much volume was lost from
your weight loss and from sagging or descent. When the face descends when one
gets older, plumping it out might not look so good because the skin doesn’t
have the tone or the resilience to hold that volume. So in the mid facial area,
augmentation can be performed with a facial implant such as a submalar implant
or a filler such as Radiesse and Restylane. I also tend to use platelet-rich plasma to
further enhance the volume in this area. I would also do fat grafting which is
taking fat from one area of the body and place it into this area to augment it
further.



In terms of affordability, I come up with different
scenarios for my patients. As long as the patient understands what those
scenarios and what the costs are, I try to come up with a
structure that is affordable but is also satisfactory. A lot of people buy
lower priced options and they end up wasting a lot of money. High quality and
cost do often go hand-in-hand. This is an investment where you will reap the
benefits after a long time. As long as you communicate with your doctor, you
should be satisfied. I hope that was helpful, I wish you the best of luck, and
thank you for your question.



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Thank you for including photos.  I don't think that you would get the best result with injectables.  However, a lower eyelid blepharoplasty (eyelid lift) with fat repositioning to fill in the hollow under your lower eyelids should provide you with very nice improvement.  It would be best to seek the advice of an experienced plastic surgeon in your area.  

Thank you for your question and pictures.When your weight stabilizes, you would likely enjoy the benefits of a lower eyelid blepharoplasty with fat repositioning.

To be sure, see two or more board-certified plastic
surgeons in your area for a full and complete evaluation to make sure you are a
good candidate and that it is safe for you to have surgery.

I hope this helps.