I’m hoping that someone can offer advice on suitability for lower eye bag surgery and what type? (Photo)

I’m a 38 year old woman & always had dark circles under my eyes. Over the last year I have noticed it worsening and bags forming (more swollen on some days) my eyes feel tired and itch, there is pressure around my orbital socket & my nose also blocks. I have (managed) hypothyroidism and have tested negative for Sjogren's, liver and kidney problems. I have been prescribed anti allergy nasal spray (effective on nose, but not eyes). Can any one offer advice, the bags keep growing - Many thanks

Doctor Answers 4

Lower eyelid bags and dark circles

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Hi. The dark circles are caused by a groove between your eyelid fat and cheek fat (nasojugal grooves). This can be improved with a lower eyelid blepharoplasty (eyelid surgery). As you do not have loose skin then this could be performed transconjunctivally, through an incision on the back of the eyelid. If you don’t want surgery then bags can be improved with a dermal filler injected to fill up the groove. These are very safe, but are only temporary, lasting 4-6 months. You should always have something temporary first to see whether you like the effect. If you like the effect then there are longer lasting fillers, which can last up to 18 months or so. Regards Dr Charles Cope

Sydney Plastic Surgeon
5.0 out of 5 stars 5 reviews

Lower Eyelid Bag Correction

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It is always hard to evaluate a condition from pictures but your "dark circles" to be an anatomic and not related to your other health problems.  It appears that you have deep tear troughs or nasojugal grooves that, because of their depth, create a dark shadow.  The shadows are getting worse because as you age you are losing volume in this area making the grooves deeper.  

Traditionally surgery was recommended for this problem but today, fillers work very nicely.  Some of my happiest patients are those that have had fillers for this problem.  I like the long term filler Artefill for this area because it creates a very natural looking result that will last a minimum of 5 years.

Best regards,

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 64 reviews

Your eye bags are too large to be camouflaged with fillers. I advise surgery type that has no impact on anatomical structure

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As a cosmetic oculofacial plastic surgeon, I perform a lot of eyelid surgery and I have a lot of experience with this type of situation. I have also been in practice for 20 years. Lower eyelid puffiness is something called lower eyelid fat prolapse. Lower eyelid fat prolapse is the fat pockets that are around the eyes that push forward. It is often a genetic issue and it naturally happens. Often it is not something related to sinus, allergies and other things. However, the eye, the nose area, the sinuses and the orbit which is the space around the eyes, all converge to a common area called the cavernous sinus where fluid drains. When there is sinus congestion and allergies, fluid tends to back-up into the soft tissue around the space around the eyes. In addition, ongoing progression of the fatty pockets will be related to some degree of the relapsing of fluid. Nonetheless, the basic anatomic issue is still the same and that is that there are fat pockets that are pushing forward causing the puffiness.

The typical solution that I offer my patients who come to my practice is to try to maximize all medical therapy to try to optimize the surgical procedure that we intend to do. Surgery naturally causes swelling and when people have issues with swelling prior to surgery, it has a significant role in how fast the swelling clears after surgery. That said, you should go to the ophthalmologist to manage any eye allergies issue and staying in touch with your ear, nose, and throat doctor. You could also go to your allergen doctor to treat allergies and sinuses to make sure everything is stable.

There are also options on how to address the lower eyelid fat prolapse which are surgical options: transconjunctival blepharoplasty which is a procedure where the fat pockets are addressed from the inside of the eyelids, or the transcutaneous blepharoplasty where the incision is made underneath the eyelashes from an external approach. From my experience, when people have issues with swelling, our goal is to minimize the trauma and respect the natural anatomy of the lower eyelid to optimize the circulation. The external approach tends to be more disruptive to the drainage system whether it’s the venous system or the lymphatic system. That leads to a more long-term swelling after surgery. So in my practice, I would perform a transconjunctival lower eyelid blepharoplasty. In so many ways, this is such an elegant approach going from behind the eyelid, not disrupting any of the support structure of the lower eyelid and strategically reducing and repositioning the fat appropriately.

In addition, there are other options to help with the skin quality and any other changes that have occurred with the skin, but doing that all in the context of the existing issue with swelling. Sometimes, this has to be a step-wise approach. We would even consider doing anti-inflammatory management prior surgery, during surgery and even after surgery to try to minimize the swelling afterwards.

Before strategically addressing lower eyelid fat prolapse, it requires a proper physical examination. I would suggest that you meet with qualified experience cosmetic surgeons who have extensive experience with lower eyelid surgery and discuss the plan and options on how to deal with issues that could come up afterwards. You have already done a lot of the baseline work to manage the sinus and allergies. These tend to be chronic conditions so it’s not like you can resolve the entire sinus and allergy completely. Meet with doctors with this level of experience and expertise to make a decision to proceed in a way that you feel comfortable. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

38 with worsening lower eyelid bags

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Most young women, in my experience, develop lower eyelid bags early because of inadequate skeletal support of their mid face.  This can be corrected surgically (with cheek implants or by removing/repositioning lower eyelid fat and skin), but in most younger women (like yourself), I find that fillers such as Juvederm or Restylane are a great way to eliminate the lower lid bags and get rid of that "tired" look without the downtime or cost associated with surgery.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 12 reviews

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.