Why Fillers are Popular but Mostly Ineffective Eye Bag Treatment & Managing Wrinkles Without Surgery


Restylane or Fractional Laser? Or Worse, Do
I Need Blepharoplasty? Hi, I’m 35 and I am very unhappy about the
area under my eyes. When I’m not smiling, I look tired with big bags under my eyes and
when I’m smiling, I get both wrinkles and excess skin pushing up towards my eyes. I’ve
looked into both Restylane and fractional laser. Would either of these help? Or both?
Or do I need full-on blepharoplasty? Thank you so much for your help. Emma Thank you for your question! I can help but be amused about the style of
your question. You asked about Restylane, laser and the final question, or a blepharoplasty. Well, what your question helps to illustrate
is the complexity of how to manage changes that affect the lower eyelids. You see, everything
you described is basically someone who comes to our practice every day and what we spend
most of our days evaluating and strategizing about. So let’s break it down and understand
what your issues are. First of all, when your eyes are at rest,
well you did a very good job at showing your eyes at rest and your eyes when you smile.
When your eyes are at rest, there is clearly volume or puffiness. And so, the question
is: what is that puffiness and what do you do about it? Well, the puffiness is something called lower
eyelid prolapse. Lower eyelid fat prolapse means that the fat this is normally around
the lower eyelid pushes forward and creates a bulge, creating this puffiness. Now, interestingly,
until recently, people would mostly consider lower eyelid blepharoplasty as a procedure
after they have tried their homemade or over-the-counter remedies which not of them work because the
fat pocket has prolapsed, pushed forward, a hernia. So a few years ago, some discussions revealed
the opportunity to help camouflage the appearance of lower eyelid puffiness with hyaluronic
acid such as Restylane. Unfortunately, this lead to the proliferation of a myth and belief
of non-surgical physicians. When I say that, I mean very often physicians who were in non-surgical
specialties such as internal medicine or pediatrics who decided that they wanted to do aesthetics
and they decided that amongst themselves and their conferences that doing injections under
their eyes to reduce puffiness is the ideal solution. And of course, to the man with the
hammer to the world with a great big nail that did not work out very well for a lot
of people. In our practice, we know that there is a threshold.
If you only have a small amount of fat prolapse, then we can very often strategically place
a little bit Restylane just in the area called tear trough and soften that transition and
buy some time before you’re ready for a definitive procedure. Now, the definitive procedure for
you would be lower eyelid blepharoplasty. Now understanding so many concerns that people
have about the risk of surgery, I spent the past 20 years developing a process such that
lower eyelid blepharoplasty is as minimal traumatic as possible. And what I do is I
do the procedure under local anesthesia with LITE IV sedation. And what that means is local
anesthesia that is like getting a little pinch of anesthetic and then getting IV sedation
which means getting some liquid volume in your intravenous and you’re relaxed. For a
lot of our patients with this appearance, I’ll do the procedure from the inside otherwise
called transconjunctival blepharoplasty. That means no external sign that there is any type
of incision or surgery. Now, then most people raise the point what
do I do with these wrinkles and when they smile like yourself, you perceive that there
is excess skin. But excess skin by definition should not be what skin is reduced when you
push the cheeks but rather, what skin is there when the face is at rest. A lot of plastic
surgeons have got themselves in trouble because they have taken out skin. The desire to improve
wrinkles and the eyelids got pulled down so this brings us to the next part skin quality
and the muscle activity. Muscle activity, you have probably heard of
dysport. These are drugs that are injected to reduce the activity of the muscle called
orbicularis oculi muscle. When that muscle contracts, the wrinkles become deeper and
this is often referred to as dynamic wrinkles. Now that the opposite or should I say the
other kind of wrinkles we talk is called static wrinkles. Now, static wrinkles have to do
with skin quality and the loss of collagen that causes the skin to thin. The lower eyelid
skin is the thinnest skin in the body so in situation like yours, I would do a combination
of Platelet-rich plasma which is derived from your own blood and is the section of the blood
or the part of your blood that is concentrated that has the platelets, the healing factors
and we combine that with fractional co2 laser. What that does is basically we are trying
to build up collagen and with Platelet-rich plasma, we actually are able to improve the
vascularity or the blood supply to the skin and such that the skin quality improves. So a typical strategy for a person like yourself
would be transconjunctival blepharoplasty with fractional CO2 laser and Platelet-rich
plasma and then as ongoing maintenance procedure or some way to keep minimize the activity
of the muscles that cause the lines to form, we would be doing Botox or dysport. So I think
what you should do is to of course discuss this with a highly experience cosmetic surgeon
who is not limited that why I lead you towards a surgeon unlike the myth that is often believed
that surgeon is not knife happy. Be at least armed and you can actually hopefully look
for someone who can understand where you are coming from and what you your concerns are
and see if you click. So once you have meet with someone that has the capability of doing
all these procedures, then limitations are less likely be a factor in the recommendation.
So I hope that was helpful for you I wish you the best of luck thank you for your question.

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