How to Treat Constantly Puffy Eyes and Loose Under Eye Skin When Filler Doesn’t Work

Thank you for your question. You submitted your question with a photo. And you are asking basically, how to treat
the aging changes in your under eye area. You describe in the details of the question
that you have been unhappy with the last two times you had filler placement placement because
you were left with the area looking lumpy. And in addition, you are concerned about the
skin getting loose under the eyes. Well, I can certainly share with you my approach
to patients like yourself who come to my practice every day. A little bit of 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. Helping under eye aesthetics with a wide range
of strategies and techniques including surgery, laser and injectables have been the cornerstone
of my practice throughout my career. And I can certainly help you appreciate the
strategies and what the logic behind the strategies are. So to begin with, there may have been a point
where you noticed some relative hollowing that seem to be amenable to the placement
of filler which is why you were doing that. And essentially, that has become a very significant
option for many people who are experiencing something called lower eyelid fat prolapse
which means the formation of these under eye bags due to the fat around the eyelid pushing
forward is to place an injectable filler in what’s called the tear trough. And it is certainly a strategy that I employ
pretty much every day in my practice to help patients who want to look good for an upcoming
event or recognize that they’re going to have surgery or want to have surgery but they
don’t have time. And it’s essentially, the strategy is also
contingent upon the level of prolapse of this area, of the fat. But what is also important and I think you
have discovered is the tissue quality. When the skin is thinner, then the strategy
of using filler becomes a little more complex because the skin can become, as you have observed,
lumpy. What I would say is that, when I look at a
patient and I evaluate their eyes, I also look at the whole picture. I look at the whole face. And I think it’s important that you take
that perspective to understand that facial aging is not limited to just the eye area
but look at how the global facial area is impacted. In particular, I would say notice the cheeks. A lot of times, people are focused on the
narrow zone of the areas of their eyes and don’t realize that cheek volume has also
diminished. So when I do an evaluation, I look at both
the eyes and the cheek. Now that being said, a strategy can certainly
be employed to address the under eye area as well as to address the skin quality. So what is routine in my practice is to do
something called transconjunctival blepharoplasty or lower eyelid surgery from the inside of
the eyelid to address the fat pockets that have pushed forward and have created this
contrast between the bulge of the fat and the hollow of the trough which is where you
are having the fillers placed. By addressing the puffiness, the trough does
not look as obvious. In addition, we routinely combine that with
a strategy of using regenerative medicine technology using something called platelet-rich
plasma (PRP). Platelet-rich plasma (PRP) which is derived
from your own blood helps stimulate collagen which is so important to address skin aging
and is very useful and helps with both the collagen volume of the skin as well as discolorations
and fine lines. In addition, we routinely do something called
fractional CO2 laser or fractional Erbium laser to help with the epidermis as well as
the dermis to help improve the skin quality, to improve some of the perception of looseness. It’s very important to understand that the
laxity you’re feeling is not really representative of excess skin. There’s a distinction that’s very important
to be made. There’s a difference between skin quality
and skin quantity. And many times, people get in trouble when
well-meaning plastic surgeons take away skin in attempt to tighten the lower eyelid which
results often in lower eyelid retraction or ectropion and we don’t have to go there. I think it’s important to recognize anatomy,
as I described, to understand the approach. So meet with qualified, experienced cosmetic
surgeons who have extensive understanding of the eye area and discuss the options that
may be useful for you and see what makes sense to you and move forward. But understand the different elements. There’s the anatomy of the fat, the anatomy
of the skin and the anatomy of the face and the cheek that are all very important to have
in harmony so that you get a nice outcome. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

1 thought on “How to Treat Constantly Puffy Eyes and Loose Under Eye Skin When Filler Doesn’t Work

  1. Dr. Prasad, in your experience, what's the recovery time when doing a transconjunctival blepharoplasty (from inside the eyelid) compared to the 'standard' blepharoplasty (transcutaneous or cutting around the eyelid)?

    Also, what's the cost in average?

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