Thank you for your question. You submitted several photos and ask about fixing hollow eyes and under eye bags. Your photos were taken in different environments, which are very helpful for me in guiding you in what I would do for someone like yourself in our practice.
A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. One of the most popular issues we provide solutions for is under eye bags and hollows. I’ll give you some understanding to the approaches based on the underlying cause, which appears from the photos is a large bulge of puffiness under your eyes, and right below it appears to be hollow.
You are dealing with lower eyelid fat prolapse, which means the fat pockets around the eyes pushed forward and created this large bulge under the eyes. Your eyes can look puffy and simultaneously hollow because of bone structure and the contrast between the puffiness causing an elevation, and hollowness right below looking like a valley.
The strategy that I generally recommend for a significant amount of puffiness is a more definitive surgical procedure called a transconjunctival blepharoplasty. This is a procedure where we go from the inside of the eyelid to address the fat pockets by reducing, sculpting, and repositioning the fat so they no longer prolapse forward. This eliminates a large amount of both the puffiness and the hollowness by contrast, and you get a more definitive, long-term benefit. This procedure is performed under local anesthesia with LITE™ sedation in our office operating facilities, which are certified by the Joint Commission for safety standards and personnel requirements so they are no different than any major hospital.
For people with lighter skin who’ve had sun exposure contributing to an aged appearance of the skin and discolorations, we’ll do a combination of the use of platelet-rich plasma (PRP) and a laser procedure. Platelet-rich plasma (PRP) is derived from your own blood and is a concentration of the healing and growth factors that help stimulate collagen and blood supply, and creates a foundation for healthier better-looking skin. A laser procedure improves the outer surface of the skin, the epidermis, and the dermis or the backbone of the skin so the skin is tighter, and has a smoother fresher look because it’s new, fresh skin. When lasers are used in combination with platelet-rich plasma (PRP), it’s a very powerful benefit overall.
There are situations in our practice where people first want to try treating eye bags non-invasively. Non-invasively is a bit of a misnomer because they are referring to the use of fillers, which I use a lot of fillers in our practice to help people with under eye hollows and mild to moderate puffiness. The thing to understand is once you enter the skin, it is an invasive procedure. It is less of an issue compared to surgery because you just go to an exam room and have the filler placed, but you are still getting a local anesthetic, so it is a procedure. We use the most minimally invasive approach, such as blunt cannulas to minimize bruising and swelling, but filler placement in the hollow is something can consider as a first line treatment, or to confirm for yourself the benefit of a surgical procedure. Sometimes patients come to us who wanted to do the surgery in a few months, but have important events coming up they want to look good for, so we’ll do a filler as a bridge procedure. You do have different options, and sometimes the filler can be combined with platelet-rich plasma (PRP) for a synergistic benefit.
That said, based on you photos, I think surgery will be more definitive for you long-term. I recommend you meet with qualified, experienced cosmetic surgeons who do a lot of eyelid procedures, and have a lot of experience with both surgical and non-surgical solutions to help the under eye area. Once you are comfortable with the doctor, you may move forward and start helping yourself look your best. I hope that was helpful, I wish you the best of luck and thank you for your question.
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