Can Eye Bags and Fat Be Removed Without Blepharoplasty?

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?

Doctor Answers 31

Be very careful about fat removal under eyes

A very common aging change in the lower eyelids is the development of 'bags', which are in most cases due to an outward bulging of the fat pads behind the lower lids. These 'bags' of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.
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.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 113 reviews

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.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 22 reviews

Transconjunctival Blepharoplasty

Since you do not have extra skin to remove, surgery can be performed through the back of your eyelid to remove only fat in order to preserve your skin. Another alternative is to inject fillet inferiorly to your fat bag in order to blend it into your cheek. This is a temporary solution which can be repeated, but allows you to avoid surgery. Good luck. 

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.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 52 reviews

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.

Eyelid surgery

No is the short answer.  It is risky to have injections to dissolve fat and not approved and could be very dangerous.  Surgery is perfect for removing loose excessive skin.

Afshin Farzadmehr, MD
Los Angeles Dermatologic Surgeon
5.0 out of 5 stars 33 reviews

Transconjuctival Blepharoplasty versus non-surgical alternative

Thank you for your question.  Without pictures it is difficult to make a true recommendation.  With that said, if you truly only have an issue with over-development of a fat pocket of the lower lid, it might be possible to perform a lower blepharoplasty via a transconjuctival incision, which would spare you a visible incision.  This approach via an incision on the inside of the lower lid, would allow your surgeon to expose your lower lid fat pockets and remove the extra fat.  

If you are looking for a non-surgical alternative to a lower blepharoplasty, your plastic surgeon could potentially inject Restylane (a cosmetic hyaluronic acid based filler) below your fat pocket into the tear trough for the purpose of camouflaging the puffiness of the fat pocket with the fullness of the upper cheek.  This is a temporary solution which can be and is often repeated over the years with results lasting approximately 6 months.  

I would recommend consulting with a board-certified plastic surgeon who is well-experienced in blepharoplasty procedures.  At the time of your consultation and physical examination, all options available to you can be discussed and a plan of action can best be determined.  I hope you find this information helpful and good luck!

Non Surgical Blepharoplasty Option

Although surgery is the only treatment that is long lasting there are a few things you can do that are of temporary help. Make sure you have an exam to make sure that you do not have weak eye muscles, ptosis, as your cause by an exam by a board certified specialist.

Lower lids: Ceramide creams for the lower lids which in minutes as they dry the clear membrane tightens the lower lid skin minimizing bags and wrinkles. This lasts from 4-8 hrs and can be reapplied as needed. Radiofrequency, laser and peels tighten the skin with minimal downtime. Fillers for fat transfer #lipoinjection, to the lower lid to fill in the cheek-lid depression that casts shadows also helps many.

For the upper lids, Botox in the crows feet area just below the brow will gently lift the lateral brow and lift a bit of the hooding on the side of your eye. This lasts about 3-4 months. Make sure you go to an expert injector associated with a Plastic Surgeon, Facial Plastic Surgeon, Dermatologist, or Ophthalmologist skilled in injections.


Hidden incision eyelift

If you have puffiness from excess fat under your eyes, but you do not have any excess skin, you can have a "transconjunctival" blepharoplasty. This procedure is done with hidden incisions that are made in the wet, pink part of the lower eyelid. See your plastic surgeon to discuss if this procedure will help with your concerns.

Lara Devgan, MD, MPH
New York Plastic Surgeon
4.9 out of 5 stars 13 reviews

Is it fat?

You could possibly get this fat removed with another surgery, however are you sure it's fat and not saggy skin or something else? Please consider first having a surgeon examine you to make sure what is causing the problem before proceeding with treatment.

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.