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Options for Minimizing Remaining Eye Bags After Blepharoplasty?

I am a young-looking 55 year old. I had lower Blepharoplasty over 3 months ago to correct what I thought were eyebags, but I'm not happy with the results. I still have the eyebags, and now I have undereye wrinkles, and one of my eyes appears bigger (I know some asymmetry is normal, but it wasn't noticeable before).

After doing a lot of reading, I now realize that the "bags" are probably malar mounds or festoons. My doctor is recommending a chemical peel to minimize the "bags" rather than any surgical revision. How does a chemical peel compare with the various laser options? What are my other surgical and non-surgical options, and should I go to an ocular plastic surgeon at this point?

Asked 37 months ago by Sueesquisite in Commack,NY

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eye bags Virtual consultation

Experienced facial plastic surgeon or oculoplastic surgeon

If the bags underneath your eyes are malar edema or festoons, this is not addressed with a blepharoplasty. Chemical peels and laser resurfacing will not minimize those bags. A mid facelift may help. If they are severe, direct excision can be performed. An oculoplastic or an experienced facial plastic surgeon could help with this problem. Under eye wrinkles can be addressed by removing a conservative amount of skin in the lower lids at the lash line. This has to be a conservative... more

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William Portuese, MD

Seattle Facial Plastic Surgeon

Lower Blepharoplasty

Sue Lower eyelid surgery (Blepharoplasty) is one of the more difficult operations. I have seen the technique of various "specialists" over the years and I don't think it matters whether your surgeon is a plastic surgeon, facial plastic surgeon, oculo plastic surgeon or cosmetic surgeon - but it matters if your surgeon is current with his or her knowledge for treating the lower eyelid. The general trend in lower blepharoplasty is toward conservation of the lower eyelid skin,... more

Daniel Reichner, MD

Newport Beach Plastic Surgeon

ASPS

A chemical peel will not help malar bags

As we age, many changes take place around the lower eyelid. The orbital fat can bulge forward and the fat overlying the bony rim can diminish causing a groove. Also, skin and soft tissue can sag over the cheekbone area causing malar bags. These bags can be extremely difficult to remove. Standard lower lid bleph does not help, and even an extended procedure onto the cheek is not without more risk and possibly a limited result. I feel the best way to smooth under the eye along with eyelid... more

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Andrew Miller, MD

Edison Facial Plastic Surgeon

You really need a good exam first

In order to determine which technique would be most beneficial for you it would be very important to understand your pre-existing anatomy. The real answer is that the appropriate procedure technique must be matched to each persons individual anatomy. It is important to understand several of the following items 1. How much laxity was there in your lower eyelids prior to surgery 2. What was the nature of your fat bulges or bags under the eyes 3. How prominent is your eyeball or globe 4... more

Jeffrey Zwiren, MD

Atlanta Plastic Surgeon

ASPS

Different issues, different treatments for eye bags after Blepharoplasty

Festoons are bags of the lower eyelid that are the result of swelling or sagging of the muscles around the eye. If it is swelling it may improve over a 6 month period. Lymphatic massage can help. If the festoons are the result of sagging muscle, tightening will improve these problems somewhat. Assymetry can be the result of natural assymetry of your face or from unequal surgery on each side of the face. This problem may be resolved if not too much was taken off initially. In any case,... more

Robert M. Freund, MD

New York Plastic Surgeon

ASPS

Malar bags and blepharoplasty

Your question could, of course, be better answered with a physical exam. Generally speaking, the lower lid is quite challenging and very nuanced. It never ceases to be a great challenge to even the most masterful surgeon. Both of the suggestions, laser and chemical peel, will help the wrinkled skin but may cause a downward traction of the eyelid and an unsatisfactory result. A great deal of caution should be taken there. From what you describe I believe some form of mid-face... more

Talmage J. Raine, MD

Chicago Plastic Surgeon

ASAPS ASPS

You might need revision surgery in the future

A chemical peel in general is not the best option for treating malar bags or festoons. Unfortunately, they are notoriously difficult to treat in general. Usually, the best chance of diminishing them is with surgery - some form of an extended lower lid blepharoplasty. At this point, I think, I would talk to a couple of other doctors, perhaps including an oculoplastic surgeon about your options. Since it had been only three months since your surgery, it would be best to wait for resudual... more

Stella Desyatnikova, MD

Seattle Facial Plastic Surgeon

Festoons are hard to treat

Dear Sueesquisite, Festoons or malar bags, if that is the problem, are very difficult to treat. I have tried deep laser resurfacing and deep Infrared skin tightening technology and been disappointed with the results. I have had good luck wiith a lateral eye/cheek lift performed through a lateral extension of the lower blepharoplasty incision. During this procedure I elevate the lateral canthus (the tendon that supports the lower eyelid) and the lateral orbicularis oculi muscle, both of... more

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Brooke R. Seckel, MD

Boston Plastic Surgeon

ASAPS ASPS

This depends on the cause of the "bags"

The answer to your question depends upon the reason you have these "bags." If they are a result of left over lower eyelid fat, treatment would be directed towards that. However, sometimes after lower lid blepharoplasty, removing eyelid fat can accentuate excess skin. In these cases removing the excess skin (carefully) will help. Finally, fine wrinkles of the eyelid skin are best treated with some type of resurfacing procedure, whether it be chemical or laser. There are many... more

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Jacob D. Steiger, MD

Boca Raton Facial Plastic Surgeon

You probably need a revision with tightening of the lower lids (canthopexy)

To Sueesquisite, Hi. I very much doubt that either laser or chemical peel alone will help you. Laser or chemical peel can pull your lower lids down and make them look rounder. This is a tricky problem and I would definitely get another opinion from an oculoplastic surgeon. You may need to have the remaining fat repositioned and skin removed from the lower lids to correct the wrinkling. This can only be done SAFELY if you also tighten the corners of the eyes with a canthopexy. The... more

George J. Beraka, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Lots of options-stick with your surgeon

There are limitations to what can be accomplished with a blepharoplasty, and it sounds like what you are describing is an issue in the upper cheek area where it transitions into the eyelid. A chemical peel can be very helpful with this. Laser resurfacing would probably do more but there is more downtime and it is not as easy to do under local or topical anesthesia, as would a chemical peel. Often the addition of volume can help to fill in the transition areas, with a dermal filler like... more

Richard Baxter, MD

Seattle Plastic Surgeon

ASAPS ASPS

There is no simple answer to this problem

I am in the business of fixing other surgeon's eyelid surgery results. Flat out, it is impossible to definitively answer your question without a personal consultation. For the right patient, a chemical peel can be helpful for addressing malar festoons and reducing or eliminating lower eyelid wrinkles. I often do just a lower eyelid peel without surgery to flatten the herniating orbital fat and reduce eyelid wrinkles. The key is proper patient selection. Generally the people who do the... more

Kenneth D. Steinsapir, MD

Los Angeles Oculoplastic Surgeon

Malar bags will not improve with peels

If they are true malar bags, then it is extremely unlikely that they will improve with peels. Malar bags are usualy due to poor lymphatic drainage on the cheeks. Think of them like when the feet swell. They will fluctuate in size. Some individuals can try facial fillers although they may make the bags worse. Have a good eye exam to figure out what they are, since people sometimes confuse malar bags with festoons (drooping muscle).