my under eye bags make me look tired at all times. Is eyelid surgery the only way I can get rid of eye bags!
How Do I Get Rid of Eye Bags?
Doctor Answers (46)
Getting Rid of Eye Bags
Lower Eyelid Fat Pads or "Bags"
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.
Structural Fat Grafting of the Lower Lid
As mentioned above, it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.
In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.
In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.
There are many causes for eye bags. Several things are often occurring at once.
- Over time, the orbital septum weakens, and fat bulges against this septum. This is seen as a bulge below the eyes.
It is usually treated by fat repositioning, and sometimes by slight reduction of the fat, often from inside the eyelid (transconjunctival).
- Hollowness develops around the fat bulge above, due to hollowing of the facial fat.
We often replace the missing fat. In our practice, we use nontraumatized fascial fat grafts (LiveFill), usually placed at the eye cheek junction and the tear trough rather than fat injection, although that is a nice option as well in the right hands.
- The cheeks fall.
In our practice, for the appropriate patient, we perform a cheeklift, often using a minimal incision, although there are many types of cheeklifts, depending on the patient's anatomy and problem.
- Loose skin can also cause a problem.
When the loose skin occurs below the lower eyelid, we strongly believe in not just removing the skin, as this usually changes the eye shape to a rounded or pulled down shape, even if minor amounts of skin are removed.
Rather, we typically perform a minimal incision cheeklift to "give" skin to the lower lid, which can then more safely be removed.
- Weakening of the lower eyelid, or canthus occurs with age.
It is often beneficial to tighten this canthus to counteract this issue.
- Skin damage caused by the sun over the years destroys elastic fibers and causes sun spots, all contributing to aging around the eyes.
Laser resurfacing with a myriad of new lasers often helps this problem as well.
For a complete discussion on these topics, you may wish to read our chapter in the textbook Mathes Plastic Surgery, in its entirety on my website (below) under Articles.
Fillers such as Juvederm and Restylane are also wonderful for filling in hollows, and are actually becoming much more popular over the last several years as they have become longer lasting.
Eye bags after a full night's sleep
Eye bags are the appearance of the lower eyelid fat pads. As we age and lose facial volume, the bags are revealed. In the past, the only way to get rid of the eyebags was by blepharoplasty, lower eyelid surgery. The surgery was performed usually from inside the eyelid (transconjunctival blepharoplasty) or through an incision in the skin just below the lash line. The excess fat was removed.
In the past 6-7 years, our philosophy about the lower eyelids has evolved. We now preserve the volume (fat) of the lower lid, and in the majority of patients are able to get rid of the bags by replacing the lost volume in the lower eyelid tear trough.
A small amount of Restylane injected in the proper manner blends the "eye bag" with the upper cheek, restoring a youthful, rested appearance to the eyes. The treatment takes about 15 minutes, is relatively painless, and the results are immediately evident. The treatment is very delicate and advanced training and ability are required. In the proper hands, the treatment is very safe and effective.
If you decide on fat transfer, your own fat can be similiarly placed. Once again, it is imperative that you seek an experienced practioner, as fat is a permanent filler. For patients with very large bags, surgery is sometimes still necessary. Once treated, instead of looking tired after a full night's sleep, you can look most rested after staying up all night.
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Lower blepharoplasty will remove eye bags
Lower eyelid bags are caused by protrusion of fat against the lower eyelid skin and laxity of the lower eyelid supporting structures. Lower blepahroplasty is required to remove eye bags.
Ignore the common internet recommendations such as cucumber slices, tea bags, and preparation H--they don't work.
External laser resurfacing and external laser treatments will not improve eye bags.
A laser blepharoplasty is very effective.
Mlodern techniques are:
- Transconjunctival lower blepahroplasty (incision on the inside of the eyelid, no visible scar and no change in eyelid shape)
- Laser blepharoplasty (laser incision causes less bleeding = less brusiing)
- Fat repositioning/fat grafting (A newer technique that removes less fat that is placed below the eyelid to plump the upper cheek depression and avoid the hollow look)
Find an experienced, up to date board certified plastic surgeon.
This is a complicated problem with many solutions, none...
This is a complicated problem with many solutions, none of which are perfect in isolation.
Three main problems that cause eye bags:
- Fullness caused by "pseudoherniation" (bulging) of normal orbital fat that surrounds and protects the eyeball or just below this area, a relative hollow that develops and is aggravated by gravitational descent of cheek fat
- Loose skin and muscle surrounding from age, heredity and environmental factors (smoking)
- Pigmentary issues related to dark discoloration with thin skin and prominent blood vessels compounded by a shadowing effect due to the contour issues (1. and 2.) listed above.
Surgical treatments include:
- Carefully remove or reposition orbital fat
- Reposition/lift cheek fat and tissues
- Reposition/tighten eyelid skin and muscle
- Fill orbital contour hollows with fat injections
Non-surgical treatments include:
- Skin care with peels
- Anti-pigment treatments
- Intense pulse light and non-ablative laser treatments for vascular pigment and skin tightening
- Soft tissue filler enhancement for hollows
Getting rid of eye bags
"You look so tired!" That's what a lot people hear who have some bulging in their lower lids, or hanging skin in the upper lids. "Eye bags" usually refers to the bulging excess fat in the lower lids. While you will be promised the moon and stars by certain creams, lotions and potions, I have not seen any promising results to improve bulging lower lids with topical treatments.
There are three fat pads in the lower lids, each of which can bulge out and make you look tired. If you have hanging excess skin in the upper lids the problem can be even worse. The only reliable way to make this look better is surgery. There are two ways to remove the excess fat in the lower lids. An incision can be made on the skin (usually right underneath the eyelashes), or the incision can be made on the backside of the lower eyelid (in the pink part that normally sits against your eye). If you have excess skin you'll need that incision on the outside (in the skin) so the excess skin can be removed at the same time. If you have bulging fat with no significant excess skin you might be a good candidate for the incision on the inside (called conjunctiva) of the lid. With the internal or conjunctival approach you might also benefit from laser resurfacing to tighten and smooth the skin at the same time.
Recovery from this procedure is usually a week or two with stitches coming out at 5 days. It's a painful procedure nor is it very expensive. Eyelid surgery is consistently the number one procedure for rejuvenation of the face every year. It's affordable, pretty easy to recover from, and takes you from "You look so tired" to " You look great! What have you been doing?" You just can't get that type of result from creams or other non-surgical options.
I hope this info helps!
Treatment of lower eye bags
Treatment of lower eyelid bags used to be blepharoplasty (eyelid surgery ) alone. With increased understanding of the aging process, we know that 'bags' of the lower lids can be caused by any of a number of anatomic issues. At the same time, our ability to treat this area has expanded with the addition of newer surgical procedures (fat sparing blepharoplasty, midface lifts, fat transfer, to a new a few) and new non-surgical procedures (injectables, peels, etc). An experienced surgeon can help determine what is right for you based on your anatomy.
Hope this helps.
Proper lower eyelid surgery can remove the lower eyelid bags
Proper lower eyelid surgery can remove the lower eyelid bags. Most often the lower eyelid puffiness is caused by a false hernia called pseudoherniation of the lower eyelid fat. Removing too much of this tissue during a lower eyelid surgery called a blepharoplasty can create a hollowed look. However, removing the right amount can lead to a youthful lower eyelid. Often this can be done with no visible incision. Also, if you have a hollowed area near the puffiness that some people call a tear trough, the fat can be rotated into that area from the puffier parts or removed and replaced into that area depending upon your anatomy and the preference of your surgeon. Fillers can also be used to fill in hollows but if you are still puffy before the filler you will be puffy after the filler. and fillers are also temporary.
The goal is for the lower eyelid and the cheek to blend smoothly
- Injecting small amounts of Restylane DEEPLY under the bags helps to create this smooth plane. In our plastic surgery practice in New York City, we do a lot of this.
- Fat injections can achieve a similar result and last much longer.
- Well-performed eyelid surgery is the gold standard. The fat in the bags must be REPOSITIONED. If the fat is just removed, you can look hollow. Also the lower eyelids are supported and tightened at the same time. The results of this surgery are essentially permanent.
Get rid of eye bags with surgery or fillers
If you have lower eyelid fat bags that bulge significantly out and create a tired look, surgery might be your best bet depending on a careful analysis of your eyelid anatomy and laxity.
The fat can be conservatively removed, it can be shrunk with a cautery device, or it can be transposed down to fill in a tear trough deformity below the bulge. However, lower eyelid surgery in my practice has become relatively rare because so much can be done by adding Restylane into the tear trough to fill in the hollow that creates such a tired appearance.
In fact, in the properly selected patient, the results you can get with Restylane are actually not able to be achieved with surgery. Plus, the lower lids are very sensitive and somewhat prone to complications with surgery, and these are largely avoided with fillers.
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.