How to resolve eye bags after PRP?

Thank you for your question. I understand you’re 41-years-old, and two months prior you received platelet-rich plasma injections around the eyes, which you refer to as the Vampire Facelift but without the hyaluronic acid filler. You also received Botox injections and experienced some bruising and swelling after the treatment. You also state you noticed the appearance of under eye bags since that time. You were advised to undergo a transconjunctival blepharoplasty, but you’re wondering if there is a gentler approach to resolving eye bags.

To first give you a little information about myself — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I studied ophthalmology before pursuing advanced training in plastic surgery of the eyes, or oculofacial plastic surgery. I am currently a member of the Vampire Facelift® network of physicians, and have been an information resource for the media with regard to the Vampire Facelift® procedure. I use platelet-rich plasma routinely in my practice for a multitude of indications such as dark under eye circles, fine lines and wrinkles, acne scars, and even as a part of a non-surgical treatment for hair loss. I also perform lower eyelid surgery quite frequently as well, so it is very interesting to me to hear about your experience.

First of all, platelet-rich plasma is a concentration of growth and healing factors needed when wound healing is occurring in the skin. It has remarkable regenerative effects on the skin, and can improve skin texture and quality. As for bruising and swelling, the bruising is a byproduct of entering the skin with a needle, and the swelling is due to the fluid from the actual volume of platelet-rich plasma itself. Sometimes the swelling can also be a response to the activity of the adult stem cells and wound healing process, which stimulates the production of new collagen.

Eye bags are due to lower eyelid fat prolapse. This means the fat that is normally around the eyes pushes forward and creates a bulge. The septum, which is the barrier behind the skin and the muscle, usually keeps this fat from moving forward; however the genetic thinning of the septum and increased volume of the lower eyelid fat can prevent this from happening.

It is possible you are dealing with a certain degree of lower eyelid fat prolapse where there are good days and bad days. Based on my own experience with patients I’ve performed surgery on for more than 20 years, there comes a point when a threshold is met — the fat will push forward and there’s nothing that can be done about it.

Some patients will have a correlation–causation type of thinking, where an event occurs and then they see the fat pockets, and then they think that there is a direct cause and effect between the two things. This is not necessarily the case, particularly with platelet-rich plasma, since there is no direct manner in which it can anatomically cause fat to prolapse forward. The reason that you were recommended transconjunctival blepharoplasty was probably because that doctor observed you had significant fat prolapse.

With regard to your question about a gentler approach to resolving eye bags, I can share with you in our practice, we have developed a gentler approach to performing eyelid surgery. When I perform transconjunctival blepharoplasty, which is a procedure I do almost every day of the week, we do this under local anesthesia with LITE™ sedation. In many ways, it is not that different from undergoing filler, but it is of course still surgery, and we don’t want to undermine that fact. We perform the procedures in our own facilities, and we are able to send the patient home after the procedure. Based on my observations, our patients have almost no bruising after one week. In fact, one can argue that you can have less bruising from a transconjunctival blepharoplasty than you would with injectable filler.

I understand why you may be a little hesitant about the idea of surgery, but it is important to understand this type of scenario can also happen when getting injectable filler. We sometimes even combine injectable fillers with these procedures, and we also routinely combine the use of platelet-rich plasma with transconjunctival lower eyelid blepharoplasty. For lighter skinned patients, we typically perform a transconjunctival blepharoplasty, followed by platelet-rich plasma treatment, and lower eyelid fractional CO2 laser or erbium laser, to help rejuvenate the entire under eye area.

That said, I hope you can find some peace of mind that it is not likely platelet-rich plasma that caused the lower eyelid fat prolapse. I suggest you wait it out for a few more months to see the degree of persistence of this fat prolapse, and then meet with a cosmetic surgeon or eyelid specialist to get additional opinions of a more definitive way of solving this issue.

I hope that was helpful and I wish you the best of luck!

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I have never heard of this happening. I can understand that there might be some pigmentation from the old bruise which is hemosiderin. This might respond to laser. I can't give you further advice without pictures. I would say that this all should get better with time however. The Facelift usually does include an HA and if this is the case, hyaluronidase would help. I think Juvederm is the usual HA used and this can cause prolonged swelling around the eyes and will get better with hyaluronidase.