Surgery Needed Again for Puffy Under Eyes Due to Allergy?

I had my successful surgery 4 years ago to remove puffy bags and cholesterol deposits under both eye (NB. I do not have high cholesterol). I have been very happy with outcome up until about a month ago. Allergy season was bad and my eyes were puffy despite Zyrtec and Nasonex. My under eyes are still very puffy, but in an uneven way. It seems like some of the fat under the eyes is returning--in fact under one lower eye, it feels like a little ball. Will I need to have surgery again?

Doctor Answers 2

Surgery puffy eyelids & allergy

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Puffy Eyes Again,

Swelling of the eyelids due to allergy is not treated with surgery. Allergies must be treated first with medication. Puffy eyelids may be due to a thyroid condition or other medical problems too.

Uneven eyelid puffiness may have many causes. The most common cause is uneven eyelid fat removal with cosmetic blepharoplasty. Also keep in mind, our eyes and face continue to age with time. Many patients have successful facial cosmetic surgery, and may require touch-up procedures or treatments to maintain a youthful appearance. Revision surgery has higher risks, including removing too much fat and creating a hollow eye.

Speak with your plastic surgeon to see if revision eyelid surgery would be appropriate for you.

Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Fat Bags, Cholesterol, and Orbital Tumors

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There are many ways to reduce the look of bags under the eyes. If there is truly a large amount of eye socket fat herniating, then removal through an incision inside the eyelid is often effective. It is possible that addtional fat can seem to return though no new fat actually grows. This is most common in the lateral (toward the ear, not the nose) side of the lower eyelid.

Lower eyelid fat can be repositioned rather than removed if there is a deep groove under the bag. Sometimes fillers (such as Restylane{tm} or Juvederm{tm}) can be used to mask the bags, but beware of overfilling in this area.

Cholesterol deposits known as Xanthelasma are seen as yellowish plaques just under the eyelid skin. These are most often medial (the nose side of the eyelids) and can be seen in upper and lower eyelids. Sometimes xanthelasma is associated with high cholesterol but more often it is seen in folks with normal cholesterol. It is good that you checked your cholesterol. These plaques can return or one can grow new areas of xanthelasma. They should not look like bags.

Allergies can make your eyelids look puffy or dark, so treating the allerigies is an important first step. Perhaps things will improve when allergy season is over. If nothing that you do is affecting or improving the "little ball" than removal of this residual fat pad can be accomplished using a minimally invasive approach in most cases.

My final concern, though unlikely, is that if there is a ball-like mass that you can feel in one eye socket (orbit), you should be examined to make sure that this isn't a tumor. There are many types of masses that can grow in the eye socket. Most are benign, some get larger with allergy or a cold (lymphangioma), some grow very slowly and feel like a ball (cavernous hemangioma, hemangiopericytoma, benign mixed tumor/pleomorphic adenoma and others). This is why every cosmetic eyelid surgeon should do a full orbital exam and not only consider cosmetic concerns.

Evan Black, MD
Detroit Oculoplastic Surgeon

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.