I've been to see my plastic surgeon about blepharoplasty. Any recommendations?

we have agreed and decided on surgery on my upper eyelids but he says the bags under myeyes should not have surgrey because my lower lids are baggy due to fluid retention from my sinuses. . Is this true? I would really like to surgically remove them instead of fillers. Any recommendations?

Doctor Answers 7

"baggy" lower lids

It is really impossible to answer this question without an examination but photos would help also.  The surgeon can tell by palpation if there is herniated fat or simply edema (fluid). The sinuses would not likely be the cause. If there is fat it can be transposed over the hollowness below the lid to give a more permanent solution than fillers.

Seattle Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Eyelid surgery

I think that you would need to be seen in person to determine what might be best for you.  If there is lower lid fat, then perhaps a conservative lower lid procedure would be appropriate.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

No one has lower eyelid bags due "fluid retention from your sinuses."

I would encourage you to post photographs if you are interested in a my expanded opinion from the Realself community.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

I've been to see my plastic surgeon about blepharoplasty. Any recommendations

A full set of photographs in addition to an examination of the lower lids is required to make a determination about what is causing the fluid pockets. The typical " bags" in the lower lids are usually caused by herniation of fat creating the puffiness look. If there is true fluid retention in the lower eyelid skin, that is not treated with surgery. Medical management and a workup for that is required.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews


weener, In my experience the majority of patients that complain of a tired look to their upper lids it is due to inferior to medial migration of the brow into the upper eyelid area. In these patients an endoscopic browlift gives the best result. Over the years I have developed a sequential approach to browlift surgery and will, in general, do one of three different lifts depending on the preoperative anatomy of the forehead. A lateral brow lift is done for patients with heaviness of the lateral brow but a normal medial brow. A 3/4 brow lift is done for patients with a heavy lateral brow and a pinched look to the medial head of the brow. A full brow lift is performed for patients who have a heavy lateral brow, pinching of the medial head of the brow and inferior migration of the medial head of the brow. This approach yields a natural appearance to the post operative patient without that surprised look.

For the less common patient who has brows that are in the correct position and yet has excess skin and muscle in the upper eyelid area, an upper lid blepharoplasty with supratarsal fixation is all they need. Should they in addition have lowering of the upper eyelid over the cornea then they may need ptosis surgery. I would recommend visiting an eye doctor should you feel this is the case for you.

Should you have a combination brow ptosis or sagging and excess upper eyelid skin, do yourself a favor and get the brows done first and the eyelids done 3-6 months afterward. That is the approach I take and the majority of patients that I see get the brows done and are happy, they leave the upper lid alone. More is not always better. For those who decide to proceed with an upper lid bleph afterwards, I can be more precise doing it secondarily.

See a plastic surgeon that specializes in facial aesthetic surgery, get two to three opinions and go with the one you feel most comfortable. For your lower lids I would recommend a "SOOF lift blepharoplasty". See the video and good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 48 reviews


Lower blepharoplasty, is one of the most tedious and unforgiven procedures in plastic surgery and requires experience to deliver a pleasing outcome. lower lid flaws may include discoloration, redundant skin, over grown muscle, bags and hollowing. Fluid can collect in the lower lids from the sinus or thyroid disease. If the problem is the fluid collection when you press on the bags with the finger tip and hold for a minute or two you can leave an impression of your finger on the bag. Otherwise, the bags are are related to the protruding fat. If the problem happens to be the fluid collection, the solution is taking care of the thyroid condition or the sinus problems. Otherwise the bags can be removed. Unfortunately, you have not posted any pictures and it is not possible to advise you properly. You can post or e-mail your pictures or seek a second opinion.

Good Luck 

Bahman Guyuron, MD
Cleveland Plastic Surgeon
4.7 out of 5 stars 21 reviews

Eye surgery

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  

1. Prolapsed orbital fat through the orbital septum (less likely in young people): treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Ezcema: much more common in young people with fair skin. This could be your issue. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also. So seasonal (sinus) allergies could be the issue. A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Unlikely in your case but can happen. Treated with mid face lift and fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 10 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.