Eye bag removal or repositioning? (Photo)

Hi, my surgeon suggests me to go for repositioning instead of removal. The other aesthetic doc said that i don't really have tear trough, the lid-cheek area is smooth. I wonder where the fat will be repositioned to? Would my eyes get more puffy by moving up the herniated fat? Any possibility to cause lumpiness? The incision will be external, hows ur experience with the scarring from your patients? I also have dark circle, is that the shadow of the hollowness around the orbital tissue? Thanks.

Doctor Answers 2

Possible Blepharoplasty for young Asian female

Thank you for sharing your questions and photos. You appear to have minor fat herniation. This could be corrected with conservative blepharoplasty, but you should consider trying fillers first. It is best to be less aggressive with treatment if possible. Scars from surgery are usually insignificant. Make sure an experienced eyelid surgeon evaluates your condition. Good luck,

You should consider non-surgical as well as surgical options for treating tear troughs

You have not specified your age, and with Asian ladies I'm always at a loss to guess accurately because they seem to age so nicely, but you appear to be relatively young for facial rejuvenation surgery.  Whenever I see a younger person with early signs of facial aging, I personally take a more conservative, less aggressive approach.  This is not to say that I don't like doing surgery if it's the only way to accomplish a specific goal, but if I can find a non-surgical, or at least minimally invasive way to address a problem, especially one in the lower eyelid, I'll always consider that first.  There are two things that I would like to point out  about your eyelids and orbital (area around the eyes) areas, but first let me say that I see the so-called tear troughs that bother you, and I understand how you would want your eyes to look better.    I do not agree that your lid-cheek junction is totally smooth, although, I think the change is very mild.  I also agree that the shadowing from the mild contour irregularity may at least contribute to dark circles under the eyes.  The first thing I would like to point out is that your skin tone, eyelid tone, and position all appear very good.  This is very important to note, because if you have normal eyelid position and tone in the tissues, things will remain looking youthful, even with more conservative treatments.  You don't have lots of loose, sagging skin or muscle, and your eyelid is not sagging down away from your globe, or your eyeball.  This is good; you should always try hard to keep it that way and avoid procedures that may alter that if you don't need to do them.  There are significant risks of pulling down the eyelid in someone like you, who already has relatively firm tissues, if too much skin is removed or too much tension is applied to the eyelid margin during blepharoplasty.  Open blepharoplasty, especially with an external approach, increases this risk due to the potential for scarring within the tissue planes of the eyelid.  The second thing that I would like to point out is that you have very minimal fat bulging in your orbits, and in fact, it looks more like loosening of the orbital septum, the tissue layer that holds our fat compartment firmly against our eyeball.  Thus, you really have more hollowing in a couple of areas than you do excess or bulging fat.  The surgeon who recommended repositioning of fat is absolutely correct.  I very rarely remove fat during blepharoplasty anymore, especially in someone whose eyes look like yours.  If you do decide to have surgery, then not only should the orbital fat be repositioned, but your cheek fat should be elevated to better cover the lateral, or outside, bony rim of your orbit, or eye socket, too.  This repositioning of fat is much different from removing fat, in that the volume is preserved, it is just moved to a better position to camouflage the bony orbit, which is what is showing right now and giving you that hollow look.  Done properly, this usually does not create any hollowing or lumpiness, however removal of fat can cause both.  You have also asked about scarring with this procedure, and in general I have had very good fortune with scarring with blepharoplasty, even in people of Asian and Middle Eastern heritage, both of which we have a lot of here in Southern California.  This is some of the thinnest skin on the body, and it typically scars very well.  However, sometimes Asian people will have visible scars just due to the pigment in their skin, and this is something that also should always be considered when contemplating surgery over non-surgical options.  A couple of other things I would like you to consider also, if your surgeon, or another one in your area, has expertise in this, is simple treatment of the hollowing with the addition of volume through either filler or autologous fat injection.  Based on your images, I think your main issue is a bit of volume loss in strategic areas of the orbit, something we see very frequently in younger people just starting to show early signs of aging.  This kind of thing can be managed very well, and very safely I might add, by injecting volume alone, without the need to open the eyelid surgically.  Of course, this can be corrected with surgery too.  I could operate on your eyelids and do exactly what I was talking about above, but I ask, why do that and incur the risk and expense if you have an effective non-surgical option?  Filler injection will not be permanent, and that may be a draw back for some people, but fat transfer would be, and it would be your own tissue.  I recommend that you give some serious though to a less aggressive approach that will leave you looking more natural, and avoid a lot of the risks that come with surgery.  Be sure to discuss all of these options with your surgeon, and be sure that he or she has the ability to offer them all.  That way you will be sure that you are getting the most unbiased information and recommendations for the best treatments to address your eyelids.  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.