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A woman has swollen dark under eye hollows. She wants to know the best treatment to address her under eye area. Dr. Amiya Prasad is a board certified cosmetic surgeon certified by the American Board of Cosmetic Surgery. He is a specialist trained in oculofacial plastic surgery by The American Society of Ophthalmic Reconstructive Surgery. That means that his background training was first in eye surgery before he specialized in surgery of the eyelids and the areas around the eyes and face. He has been in practice for over 20 years in Manhattan and Long Island. The puffiness or under eye bags represents lower eyelid fat prolapse. This means that the fat that is normally around the eyes pushes forward and creates a bulge that makes the eyes look puffy or swollen. The first line of treatment for a lot of people is they go to the store and buy various kinds of creams which claim to be able to solve these under eye puffy areas. Unfortunately they don’t work because the fat that is normally around the eyes is a volume and pushes forward like a hernia, so it also called herniated fat. Below the area of the herniated fat, the eyelid-to-cheek area and the cheek area have volume loss, which is consistent with normal facial aging. Dr. Prasad wrote about this in a book a few years ago. The concept of facial aging has two elements: volume loss, and descent or sagging. People lose bone, muscle and fat as they get older. In addition, there is descent or sagging especially when they get to their 50s or as early as the mid-40s. Depending on family history, they can start manifesting both. In Dr. Prasad’s practice, he first works on dealing with the dominant feature which is the puffiness under the eyes. The essential issue is to surgically correct that puffiness. When someone does research, they’ll learn about non-surgical options whether they’re thermal devices or injectables. However, judging by the amount of volume this woman has, Dr. Prasad doesn’t think that non-surgical modalities will be of value to her. Dr. Prasad would probably do a transconjunctival blepharoplasty. This is a procedure where he treats the fat pockets from behind the eyelid so no incision is made on the outside. He’ll also treat the skin quality and skin overall appearance with platelet-rich plasma (PRP). This is derived from the patient’s own blood and uses their own body’s growth factors and healing properties to stimulate and improve skin quality. In certain patients, Dr. Prasad uses radiofrequency or fractional CO2 laser to improve skin texture or resurface the top layer skin. This combined approach gets the maximal aesthetics. He also discusses a strategy on how to address the adjacent areas that are not as important for her right now, but may become important after the big dominant factor is reduced. That area is the eyelid-to-cheek junction and the cheek area. Depending on what’s the desired outcome, there are solutions that include improvement of volume and surgical elevation depending on how extensively they want to rejuvenate their face. Dr. Prasad does all these procedures under local anesthesia with LITE™ sedation. He has been doing this for many years and he has developed a very nice protocol so that his patients are able to recover faster and reduce the risks of having procedure compared to general anesthesia. He does the procedure in his own facility within both of his offices which are certified by the Joint Commission. This is the governing body that oversees hospitals and surgery centers for implementation of certain safety and protocols. There’s no difference between the quality of care regardless of the location as long as the safety focus standards are met and that’s of course of highest value. Dr. Prasad suggests that she meet with experienced, qualified cosmetic surgeons. These are people who specialize in eyelids, particularly cosmetic eyelid surgery, not just reconstructive but also a lot of cosmetic patients. Cosmetic surgery is its own specialty separate from other areas. It’s a matter of not just the name, but what kind of practice the doctor has. She should meet with a doctor, get comfortable, look at their before and after pictures, and understand what she could expect after the procedure. One of the most satisfying procedures surgeons do is to help people with under eye bags because people feel that they look tired. Once it’s done, it really has a transformative effect on the facial appearance. It’s almost like doing a facelift in the right candidate. For more information about eye bag surgery, please visit: http://prasadcosmeticsurgery.com/prasad-face-eyes/eyelifts/transconjunctival-blepharoplasty/ To know more about platelet-rich plasma: http://prasadcosmeticsurgery.com/dr-amiya-prasad-injectables-nyc-new-york/platelet-rich-plasma/

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