LAM FACIAL PLASTICS

Hi dr. Lam,
at first I have to apologize for my english (i'm from germany). I'm writing to you beacause my case is quite unique: i'm only 23 and developed in the last years quite severe eye bags, eye circles, my tear troughs became much worser, and some sort of hollow eye appearance because of fat loss in the cheek and upper cheek area (just underneath the eyelid). These are all hereditary changes that happened in my father also. Unfortunately I had fraxel restore 8 months ago, that was suggested to me by a dermatologist in order to treat the eye cicles (not the bags)--> he said fraxel restore woult stimulate collagen production and thicken the eyelid skin and would improve in that way the circles. Unfortunately, my fair, sensitive skin didn't reacted well to the laser that left me with (vascular) redness on my eyelids. Where he passed the laser (on my eyelids) now there is redness. It is not a strong redness but it's definetely a redness you notice/ you can see. the redness becomes temporarily very bad when i put hot water on my eyelids , when i do intense sport, when i use certain cosmetical products etc. ( like anything vascular). a cortisone cream i used some weeks after the tratment caused only a temporary worsening of the redness and also other creams didn't made any substantial improvement. i would say that it is definetely a fixed redness that becomes temporarily worser after certain "triggers", but in the long term not improved and not got worser. Maybe the v beam could improve the situation but it's hard to find somebody that uses that laser so close to the eyes. But now to my question : now i have this redness on my eyelids, but still want to fix the other things with a fat graft to the cheek area and a transconjunctival blepharoplasty for the eye bags an tear troughs (probably arcus marginalis release)... is this now still safe and possible?what effect would the transconjunctival bleph on the redness have? my only big fear is , that it could cause a permanent worsening of the redness... is having rosacea or other vascular redness on the skin a controindication for plastic surgery ( fillers, fat graft, face lift etc.)? I know that no doctor will ever be able to tell me how exactly the redness would react to the surgeries, but i would like to know if in general ( based on the experience of other people with similar situations) it is safely possible for me to procede with the fat graft and the bleph. Than you!!

you are right. no doctor will be able to tell you conclusively. speaking in general, surgeries do not worsen rosacea. what you are experiencing is hard to label. my gut is that it should not worsen it, but then again my gut would be that you would not have had your situation to begin with following fraxel. be very careful with fat transfer at your age group if done by an experienced person because fat is permanent and fluctuates with weight. i generally wait until mid 30s and beyond for fat transfer in someone with a proven history of stable weight.
s.