Can Eye Bags and Fat Be Removed Without Blepharoplasty?

Lately, an increasing number of lower eyelid bags, crinkles and crepeyness, dark circles, and tear trough derformities are being treated without surgery, i.e. a nonsurgical lower eyelid "blepharoplasty."

Before explaining how the treatment works, it is important to understand how many of the above problems come about. In youth, a robust, heart-shaped fat pad sits squarely a couple of millimeters under the lower lid. This fat pad is convex, and extends in the direction of the nose, out toward the sides of the eyes, and downward to approximately halfway in the direction of the angle of the mouth. As we age, this pad pad shrinks to a remnant of its former self, assumes the shape of a shriveled triangle, and heads Southward and inward toward the nose.

The consequences of these changes for the cheeks and lower face are not the subject of this answer. However, vis-a-vis the region under the eyes, i.e. the lower lid, we find significant elongation. In addition, the characteristically thin skin in that area (which relentlessly grows thinner with the passage of time) now sits directly over the dark blood vessels and dark muscles below it and reflects this darkness in the form of dark circles. In addition, being deflated by the loss of cheek fat, much like a balloon that has lost its air, the skin can crinkle and billow outward into small bags.

Since many of these changes result from loss and displacement of volume (fat), one quick, nonsurgical solution in appropriately selected candidates for dealing with the bags, crinkles, crepeyness and dark circles is to restore volume. A variety of substances, including Perlane, Juvederm Ultra Plus and Radiesse have been used successfully in this way. Treatment typically takes only a few minutes per side and the results are immediate. Owing to the thin skin under the eyes, bruising, mild swelling and redness are common, but temporary, typically lasting only a few days.

A physical exam is absolutely necessary to help understand what fat you are referring to, and see if it can be addressed. When I perform a lower blepharoplasty, I access the fat through the pink tissue inside of the lower eyelid so that there are no scars on the face, and no skin is removed (which can alter the shape of the eye). I meticulously remove all three fat pads that exist in the lower eyelids. However, I have had many patients consult me, having had surgery elsewhere, and I have seen countless cases where a prior surgeon has left behind one or all of the fat pockets. This might be what you are experiencing. Possibly this could be addressed in your case. If there is a lot of loose skin of the lower eyelids, I use a laser to resurface and tighten the skin. Your comment about “not a lot of elasticity left” is key, because there is nothing worse than when patients experience an ectropion, which is a violation of the boundary of the lower eyelid, when the skin pulls downward. The eye area is tricky and very delicate. I recommend consulting in person with a board-certified plastic surgeon to discuss your concerns and see if another blepharoplasty surgery is recommended to help with your goals and expectations.

Be careful with adds regarding this - there is no known efficacy.  However, if the only issue is fat - then transconjunctival blepharoplasty - from inside the lid can help - even with no elasticity.  Good luck