my under eye bags make me look tired at all times. Is eyelid surgery the only way I can get rid of eye bags!
How Do I Get Rid of Eye Bags?
Doctor Answers 61
Eye bags after a full night's sleep
Eye bags are the appearance of the lower eyelid fat pads. As we age and lose facial volume, the bags are revealed. In the past, the only way to get rid of the eyebags was by blepharoplasty, lower eyelid surgery. The surgery was performed usually from inside the eyelid (transconjunctival blepharoplasty) or through an incision in the skin just below the lash line. The excess fat was removed.
In the past 6-7 years, our philosophy about the lower eyelids has evolved. We now preserve the volume (fat) of the lower lid, and in the majority of patients are able to get rid of the bags by replacing the lost volume in the lower eyelid tear trough.
A small amount of Restylane injected in the proper manner blends the "eye bag" with the upper cheek, restoring a youthful, rested appearance to the eyes. The treatment takes about 15 minutes, is relatively painless, and the results are immediately evident. The treatment is very delicate and advanced training and ability are required. In the proper hands, the treatment is very safe and effective.
If you decide on fat transfer, your own fat can be similiarly placed. Once again, it is imperative that you seek an experienced practioner, as fat is a permanent filler. For patients with very large bags, surgery is sometimes still necessary. Once treated, instead of looking tired after a full night's sleep, you can look most rested after staying up all night.
Getting Rid of Eye Bags
Lower Eyelid Fat Pads or "Bags"
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.
Structural Fat Grafting of the Lower Lid
As mentioned above, it is very important to preserve (or restore) soft tissue volume in the lower lid. When I review with eyelid surgery patients some photographs from their twenties, in most cases we find that years ago there was no visible demarcation between lid and cheek, but instead a smooth, gently convex curve extending downward from the lower lid margin.
In patients who have developed deep 'tear troughs' at the junction of the lower lid and cheek, adjacent to the side of the nose, the meticulous grafting of fat harvested from the patient's abdomen, hips or thighs can build this area back up and nicely restore a more youthful contour. In some blepharoplasty patients this depression or 'hollow' extends horizontally across the entire junction of the lower lid and cheek, and this must be corrected to obtain the ideal postoperative result.
In select patients, lower lid rejuvenation may consist of conservative reduction (not removal) of the lower lid fat pads or 'bags', in combination with structural fat grafting of the 'tear trough' hollow immediately below. As with all aesthetic surgical procedures, it is absolutely essential to customize the surgical plan to the specific needs of every patient.
There are many causes for eye bags. Several things are often occurring at once.
- Over time, the orbital septum weakens, and fat bulges against this septum. This is seen as a bulge below the eyes.
It is usually treated by fat repositioning, and sometimes by slight reduction of the fat, often from inside the eyelid (transconjunctival).
- Hollowness develops around the fat bulge above, due to hollowing of the facial fat.
We often replace the missing fat. In our practice, we use nontraumatized fascial fat grafts (LiveFill), usually placed at the eye cheek junction and the tear trough rather than fat injection, although that is a nice option as well in the right hands.
- The cheeks fall.
In our practice, for the appropriate patient, we perform a cheeklift, often using a minimal incision, although there are many types of cheeklifts, depending on the patient's anatomy and problem.
- Loose skin can also cause a problem.
When the loose skin occurs below the lower eyelid, we strongly believe in not just removing the skin, as this usually changes the eye shape to a rounded or pulled down shape, even if minor amounts of skin are removed.
Rather, we typically perform a minimal incision cheeklift to "give" skin to the lower lid, which can then more safely be removed.
- Weakening of the lower eyelid, or canthus occurs with age.
It is often beneficial to tighten this canthus to counteract this issue.
- Skin damage caused by the sun over the years destroys elastic fibers and causes sun spots, all contributing to aging around the eyes.
Laser resurfacing with a myriad of new lasers often helps this problem as well.
For a complete discussion on these topics, you may wish to read our chapter in the textbook Mathes Plastic Surgery, in its entirety on my website (below) under Articles.
Fillers such as Juvederm and Restylane are also wonderful for filling in hollows, and are actually becoming much more popular over the last several years as they have become longer lasting.
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Surgery, Fillers and Lasers can Reduce Eyelid Bags
If one has puffy/baggy lower eyelids, there are a few approaches that may be useful in improving his/her appearance.
1) Blepharoplasty: Surgical removal of the fat pads and tightening of the skin
Appropriate for moderate to severe bags in all age groups. More permanent treatment.
2) Fillers placed in the tear trough in order to elevate the cheek to the level of the bag.
For minimal bags or dark circles. All ages.
3) Laser skin tightening procedures.
Good for sun damaged skin as well. Not great on very loose skin of severe bags.
Thank you for the question. I hope you find this helpful.
Lower blepharoplasty will remove eye bags
Lower eyelid bags are caused by protrusion of fat against the lower eyelid skin and laxity of the lower eyelid supporting structures. Lower blepahroplasty is required to remove eye bags.
Ignore the common internet recommendations such as cucumber slices, tea bags, and preparation H--they don't work.
External laser resurfacing and external laser treatments will not improve eye bags.
A laser blepharoplasty is very effective.
Mlodern techniques are:
- Transconjunctival lower blepahroplasty (incision on the inside of the eyelid, no visible scar and no change in eyelid shape)
- Laser blepharoplasty (laser incision causes less bleeding = less brusiing)
- Fat repositioning/fat grafting (A newer technique that removes less fat that is placed below the eyelid to plump the upper cheek depression and avoid the hollow look)
Find an experienced, up to date board certified plastic surgeon.
This is a complicated problem with many solutions, none...
This is a complicated problem with many solutions, none of which are perfect in isolation.
Three main problems that cause eye bags:
- Fullness caused by "pseudoherniation" (bulging) of normal orbital fat that surrounds and protects the eyeball or just below this area, a relative hollow that develops and is aggravated by gravitational descent of cheek fat
- Loose skin and muscle surrounding from age, heredity and environmental factors (smoking)
- Pigmentary issues related to dark discoloration with thin skin and prominent blood vessels compounded by a shadowing effect due to the contour issues (1. and 2.) listed above.
Surgical treatments include:
- Carefully remove or reposition orbital fat
- Reposition/lift cheek fat and tissues
- Reposition/tighten eyelid skin and muscle
- Fill orbital contour hollows with fat injections
Non-surgical treatments include:
- Skin care with peels
- Anti-pigment treatments
- Intense pulse light and non-ablative laser treatments for vascular pigment and skin tightening
- Soft tissue filler enhancement for hollows
Surgery vs lunchtime treatment for bags under your eyes
Here is how it works. As our faces age we lose fat in our cheeks and in the area right below the eyelid bags. Fat that causes lower lid bags does not get smaller as we age. In youth there is a smooth curve from the lower eyelid down onto the cheek. But as the cheek fat gets smaller with age the adjacent lower eyelid fat becomes more noticeable and looks like a bag. So our face gets hills and valleys. In the lower eyelid, often the hill is not getting higher, the valley beneath is getting deeper.
That is where fillers like Restylane and Voluma come in. The filler is injected in the office to replace your cheek fat smooths the transition from the eyelid to the cheek and effectively removes the bag.
I would suggest an evaluation with a cosmetic surgeon who is experienced with lower eyelids to see what treatment might be right for you.
What causes Dark Circles under the eyes?
Typically, the origin of such unwanted comments is the non verbal messages the lower eyelid region sends out as we age. This area can be affected by many different factors that contribute to dark circles under the eyes—the first is the convexity or concavity of the lower eyelid fat. If the lower eyelid fat protrudes into the lower lid region, it often catches overhead shadows. T
Because most light is above us in our world (consider sunlight outside and room lights inside), this light is likely to cast a shadow over the protruding fat that becomes visible on the skin under this fat in the lower eyelid. The result of the shadowing is unattractive dark circles, sending a message of fatigue or illness.
A converse problem relating to lower eyelid fat is rare but can occur occasionally and involves the lack of fat in the lower eyelid region, causing a sunken-in appearance that similarly catches and displays shadows in the lower eyelid skin. This is the second cause of dark circles under the eyes.
The third factor contributing to the appearance of dark circles under the eyes is dark pigment, which can deposit in the skin in the lower eyelid region. This is usually the result of sun exposure over a lifetime.
A forth factor patients experience leading to dark circles under the eyes is the underlying vessels transmitting through the thin skin in the lower eyelid region.
Finally, the fifth factor, which can play a role in the appearance of dark circles under the eyes, is the presence of lower eyelid and cheek swelling, known as lower eyelid, cheek festoons and malar mounds.
These are the five most common causes of dark circles under the eyes. Fullness below the eyes catching shadows, hollowing under the eyes catching shadows, brown pigment or age spots in the skin below the eyes, thin skin and redness showing through the skin in the skin below the eyes and finally, festoons and malar mounds catching shadows in the lower eyelid and cheek regions.
While these five common causes of dark eye circles can result in less than optimal non- verbal messages, there are options available to treat them that can rejuvenate the appearance and clean-up facial messages to restore effective non verbal communication. Helping patients with these issues is real joy for me because of the satisfaction I feel when patients tell me after I help them that others in the world relate to them better after these various causes of dark circles have been improved
Eye Bag Surgery a Great Option
How to get rid of under eye bags?
There are 6 common findings when talking about lower eyelid cosmetic options.
1. Most commonly, bags refer to bulging or puffiness immediately under the lower eyelashes. This is orbital fat that has nothing to do with weight gain or weight loss but exists to cushion the eyeball. It is held back by a membrane but as we age, or because of genetics, the membrane can weaken and the fat starts to push forward. If that's all that is present, an incision can be made on the inside of the lower eyelid and the fat can be removed. This is called a transconjunctival blepharoplasty. Alternatively, if under the age of 40, using a filler such as Belotero around the bag can camouflage it's appearance and works very well.
2. Item #1 is usually associated with a shadow or hollowing just below the bag. The shadowing or hollowing below the 'bag' occurs because of a different type of fat pad. There is fat on the bone below the 'bag' and that recedes as we age. The shadow occurs because you have some fat receding and the fat cushioning the eyeball starts to move forward which creates a shadow below it. Some people refer to this shadowing as their hollow, dark circle, or tear trough. Again, this hollowing can be filled to decrease the fat lost in this area. This can be performed with fillers such as Belotero or Voluma, fat injection, or using a tear trough implant. It can also be filled by reusing some of the fat that is removed from the 'bags' at the time of a blepharoplasty, and placed into the tear trough region as a fat transplant or transposition.
3. Some individuals, usually over the age of 40, have excess skin from losing elasticity over the lower lid. You can gauge how much extra skin you have by pinching the skin on the outside of the eyelid after opening you mouth as wide as you can without pulling the eyelid margin away from the colored part of the eye. If you still have extra skin after the maneuver above, then extra skin can be removed or resurfaced with a laser or peel depending on how much extra skin there is as part of your lower eyelid lift, or blepharoplasty.
4. Many individuals have overlying skin color changes which may include brown spots, generalizd redness, or blue-tinged puffiness near the inside of the lower eyelid. The redness or blue-tinged puffiness can be related to inflammation from rosacea or from fluid accumulation and extra veins or vessels in the area. This is difficult to treat and is not considered an indication for surgery. Lasers or light treatments along with topical creams and makeup make this a better treatment option. Brown spots, on the other hand, can be easily treated with peels or lasers and can be performed at the same time as surgery.
5. Individuals over the age of 40 sometimes demonstrate lower lid laxity. This refers to having some 'white' showing between the colored part of the eye and the eyelid and/or a mild 'bowing down' of the outside of the lower eyelid margin. These individuals are at risk of having the lower eyelid 'drop' lower after surgery if it isn't tightened at the time of surgery. Some individuals have a prominent eyeball or globe, and these individuals are also at risk for a lower eyelid 'drop'; this is a specialized situation and these individuals need a different type of eyelid tightening that can also be performed with their blepharoplasty.
6. Lastly, many individuals have a malar mound. This is an area of puffiness that sits over the cheekbone, close to the lower eyelid and acts like a sponge. This area can change with electrolyte and fluid changes in the body. This is not something that can usually be treated with surgery. Many women complain of swelling that they see in the morning or after a night of drinking or salty food or with allergies, that comes and goes; this swelling is associated with the malar mound. This area is difficult to treat though we have had some success using 'volumizing' fillers deep under the mound to 'squeeze' some of the fluid out of the mound itself to flatten in. Also, using the same fillers, lifting the entire eyelid complex over the cheekbone also seems to smooth out this area. In some individuals, tightening the lower eyelid muscle at time of surgery seems to diminish the appearance though this doesn't help everyone.
The lower eyelid area is a complex structure and seeing a facial specialist versed in different issues of the lower eyelid and experienced in complex reconstructive and cosmetic eyelid surgery is of paramount importance to get a natural contour and balanced result.
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.