Can Eye Bags and Fat Be Removed Without Blepharoplasty?

I have had two eyelifts on the lower lid and there is not a lot of elasticity left. However, I have fat under one eye and would like to if possible have it removed. Is this possible?

Doctor Answers 24

Be very careful about fat removal under eyes

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.
As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.
Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.

Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 50 reviews

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Nonsurgical Eyelift for Lower Lid Bags

Lately, an increasing number of lower eyelid bags, crinkles and crepeyness, dark circles, and tear trough derformities are being treated without surgery, i.e. a nonsurgical lower eyelid "blepharoplasty."

Before explaining how the treatment works, it is important to understand how many of the above problems come about. In youth, a robust, heart-shaped fat pad sits squarely a couple of millimeters under the lower lid. This fat pad is convex, and extends in the direction of the nose, out toward the sides of the eyes, and downward to approximately halfway in the direction of the angle of the mouth. As we age, this pad pad shrinks to a remnant of its former self, assumes the shape of a shriveled triangle, and heads Southward and inward toward the nose.

The consequences of these changes for the cheeks and lower face are not the subject of this answer. However, vis-a-vis the region under the eyes, i.e. the lower lid, we find significant elongation. In addition, the characteristically thin skin in that area (which relentlessly grows thinner with the passage of time) now sits directly over the dark blood vessels and dark muscles below it and reflects this darkness in the form of dark circles. In addition, being deflated by the loss of cheek fat, much like a balloon that has lost its air, the skin can crinkle and billow outward into small bags.

Since many of these changes result from loss and displacement of volume (fat), one quick, nonsurgical solution in appropriately selected candidates for dealing with the bags, crinkles, crepeyness and dark circles is to restore volume. A variety of substances, including Perlane, Juvederm Ultra Plus and Radiesse have been used successfully in this way. Treatment typically takes only a few minutes per side and the results are immediate. Owing to the thin skin under the eyes, bruising, mild swelling and redness are common, but temporary, typically lasting only a few days.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Eyelid surgery with minimal trauma

After two eyelid surgeries you must have a great deal of scare tissue.  If you worrisome fat pocket is confined to localized are, I would suggest a transconjunctival  approach to your problem.  This type of surgery doesnot require a skin incision in your lower eyelid but one on the backside of the lid.  A small incision is made and the offending fat can be removed without leaving a trace that the procedure was ever performed.  This is you easiest and direct approach to your problem.

Gary H. Manchester, MD (retired)
San Diego Plastic Surgeon
5.0 out of 5 stars 1 review

Eyelid bags correction without surgery

There are no ideal ways to remove eyelid bags without surgery.  But most important question is whether the deformity of your eyelids in fact is caused by the bags.  Only a skilled and talented surgeon can determine that, so choose wisely if you should undergo yet another surgery.

Nevertheless answer your question, one can try to dissolve the fat with mesotherapy.  This has been to shown to work, although inconsistently and unpredictably.  Another method is not to remove the bags but to camouflage them with expert and judicious use of fillers in the lower lid area.  This approach is quite technique dependent, so search out a doctor who has significant experience with this procedure.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 33 reviews

Lower eyelid revision

Skin and fat removal really isn't the best way to treat lower eyelids.  If you have had this done twice you may have a hollow skeletonized lower eyelid that pulls or is rounded. 

Lower eyelid improvement is about two things, the shape of the underlying tissue and the quality (not quantity) of the overlying skin.  Extra skin is almost never the cause of lower eyelid problems and taking skin out rarely results in improvement and is risky for complication.  Skin quality (crepe and wrinkles) is addressed with laser resurfacing. 

The shape of the lower eyelid should ideally be a smooth fullness that blends seemlessly into the upper cheek.  Probably you need to have volume added to your eyelid to blend into the pocket of fat rather than removal of the pocket.  You may also need to have your lower eyelid supported if it is pulled or rounded.  After having skin removed from your lower eyelid twice, you may no longer be a candidate for laser resurfacing because of the added tightness it creates.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

Careful transconjunctival blepharoplasty with fat repositioning best option

Revisional lower eyelid blepharoplasty is always complex and more risky than a first time blepharoplasty. The biggest risk of revisional blepharoplasty of the lower eyelid is weakening of the lower eyelid support by the incision on the outside of the lower eyelid which can lead to ectropion and change in eyelid shape.

The transconjunctival lower blepharoplasty uses an incision on the inside of the lower eyelid, thus lower eyelid support is preserved.

Persistant eye bags after two previous blepharoplasty suggests that fat repositioning or grafting into the depression beneath the lowe eyelid may help. it is common that a dark circle or depression beneath the lower eyelid makes the upper portion of the lower eyelid look puffy or baggy.

Can lower lid fat be removed with surgery?

The answer is no but you may be a candidate for Restylane to disguise the remaining fat pad. It all depends on how prominent the fat pad is.  If it's too big to hide then surgery can be performed again.  Even with scar tissue, blepharoplasty surgery can be performed successfully. An oculoplastic surgeon would be an excellent choice as they specialize in eyelid surgery and are thus very familiar with the anatomy. Good luck.

Katrinka L. Heher, MD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 4 reviews

Lower lid fat

Hard to tell without photos and so I can't tell whether it is residual fat or skin.  If there is still some remaining fat, it can be removed, but after two procedures already and no photos I can't be more specific.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 14 reviews

Two Prior Eyelid Surgeries, With Persistent Fat.

This is a very important question but likely would require a very detailed exam.  Finding the right physician with plenty of experience with revision eyelid surgeries is a very important first step.  I would ask you to bring copies of your previous operative reports and before and after photos if possible.

While additional fat removal could be combined with skin tightening procedures in a patient like you, I suspect you would most likely benefit from fat transferred into the lower eyelid.  In general, many patients with previous surgery have had most of the excess fat removed from the three fat pockets in the early surgeries.

We usually look to the fat cells in the abdominal area below the belly button as they persist the longest and have the best success rate.  The fat cells cannot be removed using standard liposuction techniques but rather are gathered with very specific low suction techniques before placement.  

I tend to recommend this is done under a twilight or very light anesthetic.  In some cases, the patients are able to tolerate this with local anesthetic in the office.

Thanks for a great question!  Best of Luck!
Dr. Todd Hobgood

Todd Christopher Hobgood, MD
Phoenix Facial Plastic Surgeon
5.0 out of 5 stars 25 reviews

Scar Tissue & Blepharoplasty

                  In someone who has under gone two previous blepharoplasties it’s virtually impossible to make a recommendation regarding the treatment of residual eyelid fat without pictures or a physical examination. Under these circumstances, your problem might not even be caused by fat, but instead by scar tissue caused by your previous procedures. The treatment of scar tissue would be different then the treatment of residual fat deposits.

                  Traditionally, when eyelid fat is present, it’s either removed or repositioned during blepharoplasty surgery. In some cases fat deposits can be hidden by infiltrating fillers into the surrounding tissue.

                  In this situation, an appropriate treatment plan can’t be made without consulting a board certified plastic surgeon with experience performing blepharoplasty. This surgeon should be able to help you formulate an appropriate treatment plan. In most cases revisional surgery will be necessary. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.