for your question. You submitted two photos,
one with you looking straight and one with you looking upward, demonstrating the presence
of under eye bags. And you state that at the age of 30 that you never had bags before but
after you had to deal with a gut infection due to a parasite; had subsequently have low
iron, ferratin levels, and B12 deficiency. You are have – you have these bags and you
asking, “Will these bags resolve after your nutritional deficiencies resolve?”
Well, I can certainly give you some perspective. I’m a board certified Cosmetic Surgeon and
fellowship-trained Oculofacial Plastic Surgeon practicing in Manhattan and Long Island for
over 20 years. Under eye bags is one of the most common issues we deal with in our practice.
And so I can give you certainly some perspective as to the systemic issue that you have and
whether or not it is relevant to the presence of the under eye bags.
So let’s first define what I – what you see when you have these under eye bags. The
– when you look straight and you see this contour of these bags, and when you look up
and these bags push out even a little bit further, this represents something called
Lower Eyelid Fat Prolapse. Lower eyelid fat prolapse basically means that the fat pockets
that are normally around your eyes pushes forward and creates these bulges. There have
been MRI studies that have shown that actually sometimes these fat pads are actually increase
in volume which is not – you know, not surprising. Most of the time these issues are more of
a generic basis where within the same family. I’ve actually operated on members of three
different generations. So, I would suspect that most likely the – as far as the diagnosis,
this is lower eyelid fat prolapse. Now, can a stress, such as parasitic infection or any
other stress accelerate lower eyelid bags from coming forward? It is possible. There’s
not enough study to say definitively but I just, anecdotally, from talking to patients,
people who have severe sinusitis, chronic allergies will often recount where these constant
issues with drainage. They – you know, eyes get puffy and then puffier, and then eventually,
they – they’re always puffy. Sometimes in medicine, temporal relationships are equated
to causational relationships and that’s not – and that’s a logical flaw. Basically
if something – if two things happen – two events happen related to your health or your
physical being, they don’t necessarily have to be cause and effect.
It is probably advisable that before you undergo any correction that you do address your nutritional
issues. I would say that although you know in our practice how we deal with lower eyelid
fat prolapse depending on the level, is either with a non-surgical approach using injectable
fillers such Restylane and the use of platelet-rich plasma which is to help improve skin quality.
Or when the fat pockets are little more prolapsed to the point where they can’t be camouflaged,
we do something called lower eyelid blepharoplasty. Now that’s a surgical procedure performed
under local anesthesia with light intravenous sedation. That means you’re not put under
general anesthesia and is performed in our office under local anesthesia. So it’s a
procedure that can be done in – approximately, in an hour and people don’t have bags under
their eyes; and it lasts a very, very long time because those fat pockets, specifically,
cannot come back. But, in the same time, it is important that a patient who is going to
have a procedure be healthy. So if you – if your nutritional issues or
any other dietary issues have to be resolved, they should be resolved since this is not
an emergent type of surgery. You want to observe maybe for yourself that after your iron levels
come back, B12 comes back, and anything else that needs to be addressed comes back. As
long – if you allow six months or a year to pass, you’ll probably then feel, like,
comfortable with the idea of doing something to intervene so that you can at least answer
the question for yourself. And from my perspective, I don’t think it’s not going to change
very much. I think that once there’s a physical change like this, it doesn’t – it doesn’t
get better on its own. But I think you should meet with doctors and
learn about your options and think about. And what we would do as someone like yourself
is we would take photos, document how you look, and then wait for your metabolic situation
to be addressed. And then I see you on follow-up, taking another set of photos, compare them.
I mean, this is clinical medicine and much of it is about observing and planning and
it’s not about just doing procedures automatically. So with that being said, I hope that was helpful.
I wish the best of luck. Thank you for your question.