The Limitations of Dermal Fillers to Treat Puffy Eye Bags, and Fast Recovery Eye Bag Removal Surgery

Author: Amiya Prasad, M.D.

Eye bag removal or filler? Hi, I am considering eye bag removal or filler for my under eye hollows. Please, could you look at my picture and tell me what you think I need doing to correct my problem. Thanks. Thank you for your question! You’ve submitted a photo of a close-up of your eye and you’re looking towards the outer corner of your eye and you are aware that you have some puffiness and you’re asking whether or not to do surgery or a filler under your eyes. So, I’ll explain how we make our decision in our practice. I’m a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island for over 20 years and this question comes up a lot because there’s increase awareness of fillers to try to soften the appearance of under eye bags. So, how do we make this decision when we see our patients? First let’s understand why are your eyes puffy? Your eyes are puffy because there are fat pockets under your eyes that we refer to as extraconal fat or post septal fat and this fat is normally behind a structure called the septum and it is pushed back.

Now a combination of factors associated with genetics and the general accepted understanding is this septum thins which results in the fat pushing forward and as well as increase in volume that causes these bulges. Traditionally, when someone has puffiness under their eyes that doesn’t get better regardless of sleep and other things associated with tired-looking eyes, we generally recommend some lower eyelid surgery. And the reason is it’s a definitive procedure. It allows for a long-term correction of anatomic issue where the puffiness is herniated fat moving forward. We call it herniated fat. Reality is that a lot of people have timelines where they maybe can’t do something within the next 6 months to a year and they want something to make the area look better.

This is where a discussion comes up as to what the expectations will be. I tend to be very conservative. As a specialist in oculoplastic surgery, I get to see a lot of patients who have way too much filler placed and it makes their eyes looking more puffy.

A lot of times its from non-surgeons, people who can’t do surgery and want to still help their patients but become overzealous and put way too much filler and they end up looking very swollen. What I do is I try to soften the transition between the bulge and the adjacent trough or valley. And so, by doing that, we can soften the transition. We use a filler like Restylane. We often combine this filler with platelet-rich plasma. Platelet-rich plasma is derived from your own blood and I find that when I combine this with Restylane, I get a very nice softening of this area that looks very natural. A lot of times, people are very concerned about bumps and irregularities because these hyaluronic acid fillers tend to have some real gel like quality and it makes them quite thick. And when we combine this with platelet-rich plasma, the platelet-rich plasma seems to work with the skin and kind of soften and integrate the material in a way that it seems to work out in our practice.

The Limitations of Dermal Fillers to Treat Puffy Eye Bags, and Fast Recovery Eye Bag Removal Surgery

Plus, the benefits of platelet-rich plasma includes generation of collagen, improvement in skin quality, improvement in blood supply. So the global area of the lower eyelid also improves. So, beyond a certain threshold, there is no value to fillers. That’s just the reality. People try to hold off having surgery.

Many times people are afraid of having surgery and so they keep on going for fillers. And when people come to us and show them example of our before and after patients and show how people look like in a week, they are often surprised to see that many of our patients within a week after lower eyelid surgery, we have less swelling and bruising than many people have when they have injections with fillers. So that being one obstacle that people are concerned about, we actually meet that concern. The other concern is the way the surgery is done. When we do lower eyelid surgery, we don’t use general anesthesia so patients are less afraid of going under a respirator and having invasive surgery. We do the procedures in our office under local anesthesia with LITE™ sedation so it becomes closer to the injectable experience even though it is still real surgery.

Based on this discussion, I think you should meet with experienced cosmetic surgeons who specialize in the area. That’s a personal bias and I think this is an area that’s very delicate and I think you should go to doctors who really work in this area a lot and have both the skills to do the surgery as well as the skills to do the injectables and figure out a plan that works for you. Judging by the photo, the fact that with you are looking towards the outer corner of your eye, you can see the bulge of fat that’s in the outer aspect. That’s the lateral fat pocket. If it’s bulging significantly, then chances are you’ll probably get more value and benefit in having the more definitive surgical procedure but that doesn’t understate the possible need to address volume adjacent to this area. You know youthful and nice-looking eyes have the absence of puffiness and nice volume in the eyelid and cheek area. So it is as always cosmetic procedures, there’s a science as well as an art to doing them.

So I hope that was helpful, I wish you the best of luck and thank you for your question!.

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