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 27

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
5.0 out of 5 stars 70 reviews

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 17 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 43 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 25 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.

Is it fat?

You could possibly get this fat removed with another surgery, however are you sure it's fat and not saggy skin or something else? Please consider first having a surgeon examine you to make sure what is causing the problem before proceeding with treatment.

Transconjunctival Blepharoplasty

Since you do not have extra skin to remove, surgery can be performed through the back of your eyelid to remove only fat in order to preserve your skin. Another alternative is to inject fillet inferiorly to your fat bag in order to blend it into your cheek. This is a temporary solution which can be repeated, but allows you to avoid surgery. Good luck. 

Lack of Anchoring of the Corner of the Eye Can Lead to Eyelid Laxity

If you are unhappy with your lids after multiple eyelid surgeries, then something is wrong.  If your eyes have lost elasticity, this can be a common issue after multiple attempts at blepharoplasty.  Often, the outside corner of the eye, the lateral canthus, can lose its attachments to the bone.  This causes a rounding effect of the corner of the eye and lower eyelid droop.  Fat can be repositioned, added, removed, etc.   But the issue here is often eyelid support to maintain shape.  I perform an advanced procedure (in which myself and several leading authors have written about) known as drill-hole canthoplasty.  This procedure restores the attachments of the corner of the eye to prevent post-operative lid distortion.  The key here is you want an experienced surgeon when it comes to revision eyelids.  Best of luck!  Dr. Pacella

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 5 reviews

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.