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A 29-year-old Asian woman says she has puffiness under her eyes, tiny wrinkles and dark circles. She wants to know if surgery will help her problems. Dr. Amiya Prasad is a cosmetic oculofacial plastic surgeon in practice for over 20 years. His background training was first in eye surgery and then he super specialized in plastic surgery of the eyelids. Lower eyelid blepharoplasty is something he does a lot in his practice. Dr. Prasad explains that puffy bags under the eyes are caused by lower eyelid prolapse. It means that the fat around the eyes has pushed forward and created a bulge under the eyes. Those fat pockets need to be addressed. There are two different approaches typically used for this: one is from the outside of the eyelid called the transcutaneous approach, and the other is from the inside of the eyelid called the transconjunctival approach. As a specialist and someone who does a lot of revision and corrective surgery for complications of lower eyelid surgery, Dr. Prasad says that a lot of people come to him who had skin removed under the eyes who didn’t need that done. This was based on a common misconception that the wrinkles are due to extra skin. Technically, most patients don’t have extra skin but had issues with skin quality. Dr. Prasad’s approach would be a procedure called a transconjunctival blepharoplasty. This means he addresses the fat pockets from the inside of the eyelids and reduces them. Then address the wrinkles with a combination of using platelet-rich plasma. Platelet-rich plasma is the concentration of growth factors derived from the patient’s own blood used for wound healing. Placing the platelet-rich plasma under the skin improves the collagen, color and the overall quality of the skin. He also uses a heating device based on radiofrequency technology to help tighten the skin under the eyes called Pellevé. Combining external heating with internal regeneration with platelet-rich plasma is a very successful approach while maintaining the natural shape and contour of the eyes. People who have lower eyelid blepharoplasty usually have a routine plastic surgery approach which is to remove what is perceived as extra skin. Through this, they often have a rounding of the lower eyelid and they look as if they are constantly staring. That condition is referred to as lower eyelid retraction and correction of that can be very complex. It can include procedures like grafting on the inside and outside of the eyelid and reconstruction. To avoid that, the proper procedure can be accomplished and done the right way from the beginning. Routinely, Dr. Prasad performs this procedure under local anesthesia with LITE™ IV sedation. This way, he avoids the complications and issues related to general anesthesia. He developed a method of delivering just the right amount of sedation so his patients are comfortable and are able to recover very quickly. It is very important in the modern world that people get back to work as fast as possible. Concerns about bruising and swelling are reduced by this method. Healing does continue to go on for months but most people are able to go back to work in one week. Dr. Prasad suggests that she should meet with qualified experienced cosmetic surgeons who have a lot of experience in lower eyelid surgery. She must get to know their work from the before and after pictures and by meeting with them and their staff and getting a sense of the level of specialty. He thinks specialization really helps ensure a higher level of care and quality. Once she’s comfortable, she can move forward with having this procedure. For more information about eye bag surgery, please visit: http://prasadcosmeticsurgery.com/pras... To know more about platelet-rich plasma: http://prasadcosmeticsurgery.com/dr-a... For information about Pellevé, please visit: http://prasadcosmeticsurgery.com/dr-a... To know more about LITE™ anesthesia, please visit: http://prasadcosmeticsurgery.com/dr-a...