I have had two eyelifts on the lower lid and there is not a lot of elasticity left. However, I have fat under one eye and would like to if possible have it removed. Is this possible?
Can Eye Bags and Fat Be Removed Without Blepharoplasty?
Doctor Answers 35
Be very careful about fat removal under eyes
As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.
In some case lower lid 'bags' can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the 'tear trough' at the medial junction of the lower lid and cheek.
Some eyelid 'bags' involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the 'crow's feet' area.
Nonsurgical Eyelift for Lower Lid Bags
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.
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Eyelid bags correction without surgery
There are no ideal ways to remove eyelid bags without surgery. But most important question is whether the deformity of your eyelids in fact is caused by the bags. Only a skilled and talented surgeon can determine that, so choose wisely if you should undergo yet another surgery.
Nevertheless answer your question, one can try to dissolve the fat with mesotherapy. This has been to shown to work, although inconsistently and unpredictably. Another method is not to remove the bags but to camouflage them with expert and judicious use of fillers in the lower lid area. This approach is quite technique dependent, so search out a doctor who has significant experience with this procedure.
Careful transconjunctival blepharoplasty with fat repositioning best option
Revisional lower eyelid blepharoplasty is always complex and more risky than a first time blepharoplasty. The biggest risk of revisional blepharoplasty of the lower eyelid is weakening of the lower eyelid support by the incision on the outside of the lower eyelid which can lead to ectropion and change in eyelid shape.
The transconjunctival lower blepharoplasty uses an incision on the inside of the lower eyelid, thus lower eyelid support is preserved.
Persistant eye bags after two previous blepharoplasty suggests that fat repositioning or grafting into the depression beneath the lowe eyelid may help. it is common that a dark circle or depression beneath the lower eyelid makes the upper portion of the lower eyelid look puffy or baggy.
How is eyelid fat removed
Eyelid fat is commonly removed during blepharoplasty or "eyelift" surgery. This can be done through an incision on the skin, or on the back side of the eyelid. The incision on the back side of the eyelid is called a transconjunctival incision and is my preferred approach for many reasons.
Remove Eye Bags and Fat
There are several ways to address fat pads without a surgical incision. A lot will depends on your anatomy. If there are hollows beneath the eyelid this can be addressed by fillers. Fat pad treatment can be performed from behind the eyelid (transconjunctival approach). This does not leave a visible scar.
Another alternative is skin tightening techniques which are laser resurfacing, ultrasound, radio frequency treatments and chemical peels.. Thermal devices and chemical peels have to be used with caution because the lower eyelid is a dynamic structure and its shape and position can be easily changed by an overzealous treatment. It is best to have a board certified physician guide you in the decision making process.
Can eye bags and fat be removed without blepharoplasty?
Thank you for your question.
In short, no they can’t. There are no non-surgical options for removing fat under the eyelids without surgery. Having said that, non-surgical options can improve the appearance of bags. For example, filler along a tear trough can camouflage bags in the lower eyelids by blending them into the cheeks. However, this is only camouflage and doesn’t actually correct the problem.
With regards to surgery, it is possible to preform blepharoplasty/eyelid surgery through the lining of the inner eyelid, which can remove fat without any external scar. While this is surgical, it is usually a shorter and simpler procedure to go through than typical blepharoplasty.
Eye bags, circles and demarcations
There are many causes of eye bags. Some are shadow issues, some are discoloration issues.
1. Prolapsed orbital fat through the orbital septum: 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. 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. 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. 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,
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.