Am I a Good Candidate for Lower Bag Removal? If So What Type? Same Time As Revision or Separate Surgerys? (photo)

I'm 3 months post op upper eye lid surgery. I have different eyelid widths and very uneven looking eyes. Not happy. Before surgery I had slight hooding on both eyes. I am willing to wait 12 months to see if I improve. My question is at that time would I be a good candidate for lower bag removal if they do a revision on the uppers? These bags bulge as seen in pics. The wrinkles don't bother me as much as the bags. I am afraid to have more scaring and don't want another incision near my eyes.

Doctor Answers 4

Waiting for full healing before revising your upper eyelid surgery, and incision-free eye bag surgery

In upper eyelid surgery, you can notice that there is variability in eyelid crease and swelling. These factors have an impact on how the eyelid appears when fully healed. Generally, it takes about 6 months for an eyelid to fully heal. At this time, swelling, tissue remodeling and maturation have occurred. For some people who have history of sinus problems, allergies, smoking or secondhand exposure, they may need more than 6 months to up to a year to fully heal. After it has fully healed, your doctor may be able to advise a revision surgery once things are stable. When the tissue is not swollen, your doctor may be precise in doing a revision surgery and it may have a better outcome.

Judging by the photos you submitted and the activity and the fine lines under your eyes, I think it is reasonable for you to consider having a transconjunctival blepharoplasty. In this procedure, fat pockets, also called herniated fat, are accessed from the inside the eyelid. People who don’t have excess skin would most benefit from this procedure since there is no outside incision. If someone has excess skin, then a combination of a transconjunctival blepharoplasty and a skin pinch on the outside would be appropriate.

In situations like yours, I would also typically do some kind of laser procedure such as a fractional C02 laser as well as platelet rich plasma to help with skin quality. It’s very important to understand that there’s a distinction between excess skin and skin quality being responsible for wrinkles. Too often, doctors will take away skin to try to remove wrinkles with the unfortunate result of something called ectropion where the eyelid pulls down or pulls outward. Of course, I can’t truly judge the degree of excess skin or skin quality without a physical exam, but by your photos I have a pretty good estimation.  I hope that was helpful to you, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Lower lid bags

Thank you for your question about your lower lid bags,

  • your lower lids are loose and have have excess skin and fat ,
  • lower lid blepharoplasty means incisions in the lower lid, they heal well,
  • I would use a biplanar approach - transconjunctival blepharoplasty for fat removal, pinch blepharoplasty for skin, canthopexy for lid support,
  • this can be done with an upper lid revision or separately, 
  • Hope this helps. Best wishes. 

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Possible candidate for lower eyelid surgery

Your pictures do show that you would be a candidate for lower eyelid surgery. If you really only want the puffiness addressed, the excess fat can be removed by going through the inside of your lower eyelid so that there would be no external scar.  Honestly, I do believe that you would have a better result by removing some of the fat and tightening the skin.  The skin can be addressed with an incision just under your lashes and this normally heals very well.  The surgery on your lower eyelids could be done at the same time as any potential revision surgery of your upper eyelids.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Lower Bag Removal, Upper eyelid revision and brow lift surgery may be your answer

Dear Steadyby,

Looking at your photos, it seems that there is asymmetry of the brow and forehead along with the eyelids.  This can account for some of your concern.  Certainly, the lower lid surgery can be performed at the same time as an upper lid revision or brow adjustment. A discreet incision along the lower lash line may be required, but would be very difficult to see once you have healed. Wishing you all the best, Evan Black, MD, Oculoplastic Surgeon, Southfield, MI

Evan Black, MD
Detroit Oculoplastic Surgeon
5.0 out of 5 stars 1 review

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.