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Lower Blepharoplasty for Bags from Muscle?

asked 3 years ago by daisy83461 in Jacksonville,AR
Latest answer by Roger J. Friedman, MD
Question viewed 5,801 times
Tags: eye bags

I am scheduled for an upper and lower eyelid lift for bags under my eyes. The bags are not fat. My doctor says it is muscle, and although he cannot remove the bag, he can make it less noticeable by removing skin. Does this sound accurate?

16 answers to Lower Blepharoplasty for Bags from Muscle?

Surgery may not always be the answer for eye area rejuvenation

There are both surgical and non-surgical options to rejuvenate the area around the eyes. Non-surgical treatments such as Botox Cosmetic, Restylane, and Juvederm can help in the early stages of the aging process. Although these treatments are not permanent, Crow’s feet, Furrows and Dark circles can be softened and often eliminated with these treatments. The eye is surrounded in the orbit by fat. The fat surrounding the eyeball is a very low density fat, unlike the fat in the rest... more

Lawrence Scott Ennis, MD
Pensacola Plastic Surgeon

Consider your options for eye bags

First, let me say that there is no subsitute for an in-person consultation, so I can only make general comments. If the problem is truly the muscle, then one option is Botox, though this must be done by someone with specific expertise for that. Looking at your picture, what I notice is a lack of volume in the area where the eyelid transitions into the cheek. This can often be improved by injections of a filler such as Perlane or Juvederm, or with your own fat. In any case, making an informed... more

Richard Baxter, MD
Seattle Plastic Surgeon

Lower eyelid lift for muscle

To start, it would be helpful to see a picture from the front as well a picture with you smiling. If when you smile there is a roll under your lashes, this would be consistent with an overactive muscle which can be addressed by thinning out the muscle at the time of surgery. From the side view, it also appears you have a hollow just below your lid which is referred to as a tear trough deficiency. This may be improved upon by either an injection of a filler or taking some... more

Roger J. Friedman, MD
Bethesda Plastic Surgeon

A lower eyelid blepharoplasty is not done for muscle

A lower eyelid blepharoplasty is not done for muscle. Normal lower blepharoplasty is performed primarily for removal of fat bags in the lower lids and a very minimal pinch of excess skin on the lower lids, if necessary. No muscle is removed from the lower lids. If that is done, the lower lid can retract and give a more hound dog look.

William Portuese, MD
Seattle Facial Plastic Surgeon

Several options for your under eye bags

You may need lower blephoplasty and cheek lift with tear trough implant. You have weakness of the cheek bone under the eye, and not enough support for the eye fat pockets. You will benefit from injectable that will last 1-11/2 years. The other option is lomer eyelid with the use of tear trough implant. Please get multiple consultation.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon

Midface dermal fillers would help you considerably

Looking at your picture, I think you could benefit from midface injections of fat or dermal fillers. These injections can also help smooth out the cheek-lid junction and improve your lower lids problems. This is just a thought and may be less drastic that the other procedures you are considering.

David Shafer, MD
New York Plastic Surgeon

Lower Blepharoplasty not recommended for you

Daisy, I don't recommend a lower blepharoplasty in your case. You have a negative vector, which means that your lower orbital rim and cheek are posterior to your lower eyelid. A standard lower blepharoplasty would create a greater depression below the eye and might even cause your lower eyelid to retract. I recommend adding volume to your lower tear trough and eyelid/cheek junction. Your surgeon can use a hyaluronic acid filler or micro fat grafting. I would also suggest that you... more

Daniel Reichner, MD
Newport Beach Plastic Surgeon

Muscle bulge causing eye bags usually requires modification of the muscle during blepharoplasty.

From the side view photograph you provided you look very young to e considering blepharoplasty. If you send me a frontal face view photograph which is a close up that includes your eyes, nose and forehead, i can give you a better opinion. Just send as an email attachment to my website listed above. Lower eyelid blepharoplasty is a serious operation and one which should not be approached lightly. If you have bulging muscle causing the "bag' appearance, then a routine skin blepharoplasty... more

Brooke R. Seckel, MD
Boston Plastic Surgeon

Lower blepharoplasty may be an option

Hi Daisy, From the single profile view you have forwarded with you question, it is difficult to fully answer your question. However, what are you looking to accomplish with eyelid surgery? Do you have a clear understanding of what your doctor is looking to accomplish ( i.e are the two of you on the same wavelength?)? You have a slightly heavy upper eyelid fold. How much of your upper eyelid fold does your doctor plan on leaving? You definitely what to preserve the upper eyelid fold. It... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

I would consider volume enhancement

Looking at your photo, I would consider fat grafting for volume enhancement of the under-eye hollows. Alternative, injectable fillers represent a viable non-surgical option. Personally, I am not sure that skin removal will be very effective in improving the "bags". In fact, it is the volume deficiency underneath them that benefits from correction.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon

Malar bags difficult to correct

Sounds like you have "malar bags", which represent the lower, outer corner of the orbicularis oculi muscle. These can be difficult to correct, and typically can only be minimized as you mentioned. In my experience, some form of muscular tightening is necessary in addition to skin modification.

Michael A. Marschall, MD
Chicago Plastic Surgeon

Be very cautious with blepharoplasty

I do not have the advantage of examining you and that is the only way you can determine what effect the orbicularis muscle has on your "bags", since that is a dynamic effect. However, you look quite young and your lateral photos reveal a negative vector alignment of your peri-orbital anatomy. This is a dangerous situation to perform a "typical" blepharoplasty. My sense is that you have relative "bags." That is, your bags only appear to be bags because the... more

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Does not look like you need any surgery

Judging by your picture, which might not be ideal, it does not look like you need any surgery on your eyelids, upper or lower. Removing the skin can create problems that you don't have now, and your upper lids look fine on this picture. Sometimes, a little drop of Botox can make the muscle ridge less prominent on lower lids, and it might be all you need.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

I advise caution on lower blepharoplasty for this case

Your side view shows that the lower lid is somewhat low to begin with, and your eye ball may even be a bit far forward of your cheek bone. I don't know how good the elasticity is either. I would be worried after surgery that you will have scleral (white of the eye) showing. You may benefit from an upper bleph, or endo brow. I really need to evaluate you for either. I am concerned about the lower lid however. Proceed with caution, and be sure to understand what the end results will be so that... more

Scott E. Kasden, MD
Dallas Plastic Surgeon

Removing the lower eyelid bag that is not fat

There is a procedure where you can remove a small amount of muscle, which can reduce the fullness under the eyes caused by muscle hypertrophy. Muscle hypertrophy occurs when people use the lower eyelid muscle to squint, and thereby causing an increased thickness of the lower eyelid muscle. Some people also have this propensity genetically. Removing skin will help with excess skin or crinkles that occur to excess skin, but typically they do not solve fullness issues. You appear young and... more

Lenore Sikorski, MD
Laguna Niguel Dermatologic Surgeon

Lower eyelid muscle bags can be helped

Yes, this is possible. I have seen quite a few patients over the years whose muscle of the lower eyelid is thickened. During the lower eyelid procedure this muscle can be trimmed to render it less prominent. There are different opinions about lower eyelid surgery with one being that the muscle should not be disrupted. In the situation of a thickened muscle, I have found that trimming it or removing some of it is beneficial. I would seek the opinion of the surgeon doing the surgery and... more