Skin Pigmentation Darkening

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Eye Bag Surgery in Dark Skin Methods for Avoiding Permanent Pigmentation

Thank you for your question. You're askingif there's scarring and discoloration after eyelid surgery. And you write in your questionthat you're of African descent and then you're choosing to undergo transconjunctival blepharoplastybut you have a concern about hyperpigmentation. And you're asking is there a way to avoidthis. And you're also reflecting on the possibility of – are you trading of puffiness for discolorationéWell I can certainly give you my approach – or explain to you my approach to situationslike one you're in. I'm a board certified cosmetic surgeon and a fellowship trainedoculofacial plastic and reconstructive surgeon practicing in Manhattan and Long Island forover 20 years. I do a lot of cosmetic eyelid

surgery and the focus on ethnic skin typeshas been a significant mission in my practice for the past 20 years. In fact I was one ofthe first to write articles about unique situations that are specific to ethnic skin types asit relates to eyelid surgery. So I will explain to you how I approach thissituation and give you an explanation as to what you're experiencing. To understand thatskin of any pigment that is let's say darker than olivecomplected has a tendency to haveinflammation – pigmentation related to any type of inflammation. Many people with darkerskin will say that if you get a pimple and they leaves them with a blemish that lastsfor months.

Now when it comes to eyelid surgery for puffyunder eye bags, there's no question in my mind that the transconjunctival approach isthe optimal approach. For the majority of our patients who come, it's not usuallythe case that it's excess skin that would justify going in from the outside to takeaway skin. And even if there was some excess skin, I still do a transconjunctival approachand I combine it with something else externally. So which brings us to then what happens postoperatively.Number one you're not going to have the bags anymore. So that is the purpose and the desiredoutcome. But what will you have in the shortterm. Most people will have some degree of hyperpigmentation.It's just a natural skin reaction.

Now we try to very often, even with peoplewho are relatively young, mitigate both the hyperpigmentation response as well as improveskin quality with something called plateletrich plasma. Plateletrich plasma is drawn fromyour own blood. And what we're doing is we're concentrating the healing growth factorsthat are responsible for wound healing. And we found that there is actually some degreeof not only improvement in skin quality but it's been my observation that patients tendto have less discoloration and hyperpigmentation. Still on a case by case basis to say thatyou cannot get any hyperpigmentation is not realistic. Your skin type can get dark very,very quickly. But let's differentiate reactive

hyperpigmentation to permanent hyperpigmentation.So from that respect, as long as the trauma of surgery – the use of heating and othermodalities that limits this natural response, then when that's done, and basically themost – in the most gentle way, I would say that you're going to have only reactive andtemporary pigmentation. I tell our patients that it is normal in thefirst couple of months to have some darkening under – the under eye. And then as the monthsgo – continue, you will find that it basically goes back to your baseline skin color. Insome situations, with the benefit of PRP, the skin quality looks better, and hence theskin color looks better.

So that being said, you may want to inquirewith your about PRP or plateletrich plasma. It's not a very popular modality.A lot of s have yet to be properly educated about this modality which already has beenestablished very well in oral surgery and in orthopedic surgery and in any literaturesearch in the National Library of Medicine will show hundreds and hundreds of articlesin the benefits of PRP. The problem is, in the modern world where there's so much messagingfrom very large companies for a very high priced, high ticket items such as lasers andinjectables, something as simple and elegant as plateletrich plasma gets lost in termsof knowledge and dissemination. And physicians

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