How Treating Eye Bags with Filler or Surgery is Determined

How Treating Eye Bags with Filler or Surgery is Determined

Under eye fillers have become a popular and
convenient way to help improve the appearance of under eye bags. Filler placement under the eyes require no
surgery, and can be performed in minutes to help camouflage under eye bags.. This procedure can be performed with minimal
to no bruising. It’s important to understand that under
eye filler cannot be used in all cases of under eye bags, and that surgery is often
the better option. I’m Dr Amiya Prasad. I’m a Board Certified Cosmetic Surgeon and
Fellowship Trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long
Island for over 20 years. As a cosmetic eyelid surgery specialist, I
perform a wide range eyelid procedures every day such as eye bag removal, treatment of
upper eyelid hooding, Asian double eyelid surgery, and oculoplastic specialty procedures
such as eyelid ptosis correction, orbital and lacrimal system surgery.. I am also well known for my work with injectable
fillers for the face, particularly in the the eye area, cheeks, chin, jawline, and forehead. Essentially, unlike physicians who cannot
perform surgery, I am not limited or biased in treating the under eye area with any modality. Many people with under eye bags are relatively
young and often hesitant to consider surgery preferring to have the under eye area treated
with filler. While eye bags can occur and become more prominent
due to age, they are mostly caused by genetics, and can occur as early as during the teen
years, and in some cases even younger. So, what are eye bags ? Eye bags are caused
by fat. Fat normally surrounds the eyes can push forward,
like a hernia. This is why the fat that causes eye bags is
referred to as herniated fat. Fat herniation under the eyes is called lower
eyelid fat prolapse. During consultation, I look at the prominence
of the fat and relationship of the herniated fat to the surrounding bone structure. For example, there is an area below the under
eye bag referred to as the tear trough. I look to see if the puffiness can be blended
with filler in the tear trough. Generally, I use soft tissue fillers such
as Restylane or Juvederm in this area as long as the under eye bags aren’t too prominent. It’s important to understand that fillers
improve the appearance of eye bags, not by reducing projection, but by adding projection
to the adjacent area. In some situations where the bags are too
prominent for optimal blending, I perform this procedure as a short term solution for
people who want to look better and will undergo surgery later on. If the under eye bag projection is past a
certain limit, as in the case of more prominent or severe eye bags, then adding additional
volume may not blend the contour of the eye bags, and actually add more puffiness to the
area, making the eye bags look even more prominent. When selecting a doctor, keep this in mind
that many doctors who are not surgeons will choose filler to treat all eye bags cases,
which means in many situations, the filler placement can result in bigger eye bags. When eye bags are past a certain level of
projection, fillers are not appropriate and surgery is the treatment of choice. This surgery is referred to as lower eyelid
blepharoplasty. There are two techniques, one is called the
transcutaneous approach where an incision is made below the eyelashes, to address the
fat bags. The other approach is referred to as the transconjunctival
approach where the fat pockets are addressed from the inside of the eyelids. In practice, it is common for many doctors
to perform the transcutaneous approach to also remove eyelid skin in an attempt to reduce
wrinkling. In almost all cases, I strongly advise that
lower eyelid skin not be removed as it can lead to complications such as rounding of
the eyes, or eye exposure from skin shortage known as lower eyelid retraction. Oftentimes, the inside of eyelid is exposed
and irritated is due to skin removal. This condition is referred to as ectropion. My preferred method is a more specialized
technique called transconjunctival blepharoplasty, where no external incision is made. I approach the fat pockets from the inside
of the eyelid to sculpt the fat. Since no external incision is made, the results
look natural, as if you never had eye bags. This method preserves the lower eyelid support
structures since no skin is removed, and the anatomy of the eyelid is not compromised by
disruption of the muscular support.. When performing eyelid surgery, I most often
sculpt the fat to remove the bulge, but leave some fat behind to create a smooth contour
in the lower eyelids, and prevent the lower eyelids from looking hollow. Lower eyelid surgery is an art, so not all
surgeries are performed the same way. Having this procedure done with no external
incision allow the results to appear natural, and preservation of fat to prevent hollowed
appearance provides for optimal outcomes when performed by experienced surgeons. Injectable fillers placed under the eyes is
routinely performed with topical anesthetic for patient comfort. In addition, fillers like Restylane are also
contain some anesthetic. I usually prefer instruments such as blunt-tipped
cannulas instead of needles to reduce the risk of bruising after the procedure and minimize
swelling caused by repeated needle entry. Generally there is minimal downtime and I
see the patient again two weeks after the procedure to see how the filler has settled,
and if additional enhancement is needed. In my practice, eye bag surgery through the
transconjunctival method is performed with local anesthesia, with LITE sedation for comfort. I prefer local anesthesia with sedation for
almost all my surgeries as my patients are more comfortable and able to avoid the recovery
from the side effects of general anesthesia. Consequently, my approach results in easier
recovery and fast healing from the surgery. Surgery in my practice is performed in our
own in-office surgical suite, certified by the Joint-Commission for standards of safety
and sterility. Patients routinely go home after surgery without
any difficulty.. As far as downtime, patients can return to
work pretty much immediately after under eye filler. In fact, many patients do it over their lunch
hour, and return to work afterwards. There is the possibility of of some bruising
after the procedure which typically fades in a few days. When performed with local anesthesia, lower
eyelid surgery patients return to work in about a week. Interestingly, we have found that the limited
bruising from lower eyelid surgery can be comparable to the bruising seen with the use
of fillers. Oftentimes, patients have much less bruising
after my performing lower eyelid surgery than patients who’ve had filler procedures done
elsewhere. The techniques I’ve developed over my career
combined with the systems for care and recovery allow my patients to recovery from lower eyelid
surgery much faster than traditional surgery. I discuss with my patients how to look at
their options from a perspective of procedure longevity. Softer hyaluronic acid fillers like Restylane
can last 6 months to 1 year before they are eventually and safely broken down by the body. The benefits of lower eyelid surgery can last
many years. Once fat pockets are removed, those fat pockets
don’t come back. While there is a chance that other fat around
the eyes can prolapse forward the eyelid appearance can be stable for many years. Neither fillers or lower eyelid surgery address
skin quality such as crepiness. Supplementary procedures for eyelid skin rejuvenation
treatments like laser resurfacing, wrinkle treatment, and platelet-rich plasma may be
considered to address crepey skin, pigmentation and wrinkles. When can you look good for an event: If you
want to look good for an event, both filler and surgery can be performed on relatively
short notice. I look at each individual situation and make
recommendations based on my experience. Filler placement is a convenient option for
limited eye bags, with minimal to no recovery. Lower eyelid surgery is a more definitive
procedure that can be performed for any degree of fat prolapse, with results as if you’ve
never had eye bags or surgery. Patients often choose to have filler placement
under the assumption that they don’t have time for surgery recovery. In our practice, applying modern, faster healing
methods, recovery from eye bag surgery can comparable to the time it takes for filler
results to settle. Lower eyelid blepharoplasty really brightens
up the whole face with minimal surgery. In fact, many patients who I’ve operated
on, comment on the ease of their experience with their procedure and state that if they
had been previously aware of how easy it was, they would have done it sooner. I hope you found this information helpful…thank
you for your question


  • gerik jini says:

    Sir, do you come to india for consultation and surgery?

  • barbie doll says:

    My eyez have deep tear trough.n i hate them😥

  • pulgini1002 says:

    WOW! Your amazing! Love your videos. If you were closer I’d already been to you! Planning a trip to NY soon, will schedule appointment.

  • Zoe Mutti says:

    Hi Dr., your video is very helpful.I have been considering blepharoplasty for a long time but I have consulted with a surgeon twice but was declined as he said I do not have fats under the eye but hollowing instead. He recommended laser and fillers but I find those temporary. So I thought of transcutaneous blepharoplasty to remove a little bit of the skin under the eyes. But having seen your video, made me change my mind about transcutaneous. Will a transconjunctival blepharoplasty be helpful for hollowing under the eyes? Thank you.

  • Trisha Devi says:

    I went to an ocuplastic specialist for a fat pad I have underneath my left eye only. Would you recommend a filler or blepharoplasty.? I wasn’t to confident to let her perform after she told me if she doesn’t remove enough of the fat and I’m not pleased that I will have to return. Keep in mind it’s only one eye with a fat pad the other eye has no bag or hollowness at all.

  • Ruggero Nesi says:

    Hi Dr. in the transconjuntival method are there any stitches? How do you perform the procedure?

  • Nabin Stha says:

    Is there any yoga or exercise to reduce eye bags??

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