Under Eye Bags Still Prominent After Blepharoplasty

Dear Dr,
It's already 3 months since I had transconjunctival lower blepharoplasty done
however the problems I encountered since 1 month after surgery still persists. (hollowing under my lid and my under eye bags are still very prominent under lights)

I'm not sure the bags are due to edema or residue fats, my surgeon say my eyelid need few months to settle down but it seems like I look worse before my surgery.
I'm really worried, depressed and regretting for my decision; your advice will be greatly appreciated.

Thank you very much.

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recommendation under eye bags

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8 Doctor Answers | Asked by Pufferfish in USA

Doctor Answers (8)
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Puffy eyes 3 months after blepharoplasty may require revision and fat grafting

The fullness at the bottom of your lower eyelids following transconjunctival lower eyelid blepharoplasty may be edema but is more likely residual fat. Did your sureon perform fat grafting or fat repositioning? If so, the fullness may go daown with massage over the repositioned or grafted fat. If the surgeon did not do fat grafting or fat repositioning then a revision procedure may be required. Fat can be harvested from tour abdomen and transplanted into the hollow area below the... more

Revision surgery

The goal of a transconjunctival lower blepharoplasty is to remove the fat bags underneath the lower lids. It is impossible to have residual fat bags and hollow eyes at the same time. If there is still fat residual remaining in the lower lid, this can be removed through an additional transconjunctival approach. If there is hollowness in the eyes, this can be addressed through fat repositioning or reimplantation. It has been three months after the surgery and most of the healing has been... more

Likely you will need a revision

Nowadays we strive to remove enough fat to improve the appearance of the lower lids without removing so much that the patient is left with a hallow look. The transconjunctival approach is excellent for this. However, it the approach is done low in the conjunctiva than appreciation for SOOF fat is not appreciated. SOOF fat or subobicularis oculi fat is fat deep to the muscle but superficial to the septum. This is more common in certain ethnic groups. I think that is the fat you're seeing... more

You can try Restylane injections.

To Pufferfish, Hi..I certainly see what you mean. Unfortunately, I don't think this will go away after 3 months. Restylane injections, in VERY small amounts, injected DEEPLY and carefully, just under the bags, can make this area look better. But be sure you see someone with experience. Otherwise, you will need a surgical revision, repositioning the remaining fat. I know this is not what you wanted to hear.

Fatty herniation

Your result from the lower eyelid surgery can be better. You have negative vector and this means that your check bone is not providing enough support fo the fatty tissue that surronds the eye. As Dr.Fechner answered your question ,you have multiple option. 1) lower belpharplasty and tear trouph implant to support the eye fat pad 2) filler to augment the soft tissue( temporary and may have problem with the puffiness I would wait at least 6 month

Kamran Khoobehi, MD

28 reviews

New Orleans Plastic Surgeon

Wait and let yourself heal after blepharoplasty

Without seeing your before photos, it is difficult to give a definitive answer. However, what you are experiencing is something every surgeon has had on occassion. I would suggest waiting until your surgeon feels things have settled down to the point where you could consider either additional fat removal or possibly filling in the trough area, probably with Juvederm. The other option is to leave well enough alone, as there may have been something about your particular anatomy and healing... more

More time to heal is almost always a good idea

Dear Pufferfish, Transconjunctival lower eyelid surgery removes fat from the lower eyelid. The goal is to improve the contour of the lower eyelids. It is unclear if the fullness seen in your lower eyelids actually represents true herniated orbital fat or merely the descent of the cheek fat that once met the lower eyelid fat to form a continuous fullness into the lower eyelid crease. Certainly the residual full in your lower eyelid does represent residual lower eyelid fat. However, I... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Puffiness after lower blepharoplasty

At 3 months, you are probably looking at about 95% of the final result. From the photo I get the impression that your problem lies not in the fat herniation ("puffy") of the lower lid region but also in the hollowness of the tear trough. Further improvements can be accomplished in 3 ways: 1. additional fat removal 2. filling of the tear trough (fat transfer, injectable fillers). 3. combination of both. I would wait for a minimum of 9 months before considering any surgical... more