A male in his early 20s has eye bags and loss of volume at the eye-cheek junction. He wants to know the best treatment for his situation.
Dr. Amiya Prasad, an cosmetic oculofacial plastic surgeon, explains that in the absence of a physical exam, it’s very difficult to make a definitive recommendation. People like him are in a situation where it’s more about the volume loss than it is about the fat prolapse. Thanks to more recent fillers, it is actually possible to camouflage that transition or restore a little bit of volume along the orbital rim. This area is referred to as the V deformity. Basically, it is just a relative hollow.
In Dr. Prasad’s practice, he routinely uses hyaluronic acid such as Restylane. He has also been doing a combination of hyaluronic acid with platelet-rich plasma. There has been some very well established information of the synergistic effect of platelet-rich plasma. Platelet-rich plasma is derived from the patient’s own blood and contains growth factors and helps improve skin quality. Hyaluronic acid provides some volume and there’s collagen deposition that helps to improve these areas more long- term. A lot of his younger patients appreciate avoiding surgery and having this type of treatment. If the fat pockets underneath their eyes are too prominent, then he recommends a surgical procedure.
Dr. Prasad cautions patients about fat grafting. Lower eyelid skin is the thinnest skin in the body and is about half a millimeter in thickness. In his experience, he had many patients from all over the world that have him treat them because they had fat grafting and they ended up with a lot of irregularities, scars, lumps and basically things that are very complex to deal with.
Dr. Prasad thinks that this man’s puffy under eye bags are not that prominent and he can use a hyaluronic acid filler. However, there’s an art to doing this. It may take a doctor more than one treatment to get it right but it’s the least invasive and most effective way to treat someone. Hyaluronic acid can last from months to over a year, but there’s some variability. If a person is doing anything that is any way toxic to their skin then it’s advisable to stop, including: smoking, trying to lose weight and doing any crash dieting or even drinking excess alcohol. These are things that are very toxic and can advance the aging process.
He should consider fillers as a starting off point before moving ahead with surgery. Again, in the absence of a physical examination, it’s hard to appreciate this man’s situation in 3-dimensions.
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