Puffy bags under eyes after having gotten Asian blepharoplasty? (Photo)

Hi! I am a 20 year old asian woman who received the double eyelid surgery 2 yrs ago. Only after my surgery, I developed severe "eye bags" that are more prominent when I am smiling/squinting my eyes, but nevertheless visible even when my face is relaxed. They are not due to lack of sleep or stress, and they cannot be covered with heavy makeup. Are these bags the result of hormones, or perhaps due to a mistake/natural side effect in the surgery? What surgery would I need to get rid of them? Thanks

Doctor Answers 5

Upper eyelid surgery is not anatomically related to lower eyelid surgery, so it is unlikely to cause eye bags

Thank you for your question. You are 20-years-old, and submitted several good photos with your question where 2 years prior you underwent Asian eyelid surgery and you’ve been aware of puffiness under your eyes subsequent to that procedure, and you want to know if the puffiness related to hormones, or to the original surgery, and what is the solution.

I can share with you my approach to this type of issue when it comes up in our practice. A little background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years.

I specialize, among several things, in Asian eyelid surgery and I’m quite familiar with the type of surgery you probably underwent 2 years ago, and I deal with under eye bags all day long in our practice.

I will give you the simplest, straightforward understanding of what you dealing with. These under eye bags, especially as you describe when you smile and wink are bulges of fat, technically called herniated fat. It’s fat that is normally around the eyes that pushed forward and created these bulges. The cause is generally a genetic trait often seen in families. It’s not likely they are the result of upper eyelid surgery because anatomically speaking it doesn’t make sense. If you are working on the upper eyelid, there is no trauma or any type of procedure that could’ve caused some change anatomically in the lower eyelid, so don’t worry that the upper eyelid surgery has something to do with this.

Whether hormones or other factors play a role in the expression of fat are not likely the cause, unless you have issues related to thyroid disease. There is something called thyroid-related immune orbitopathy or Graves’ disease, but it is not likely to be the case in your situation based on your photos.

If you have concern about hormone levels, this type of situation may be with the thyroid since no other history is indicated, meet with a doctor about this because it is important to diagnose any type of hormonal issue before moving forward with a solution for under eye bags.

As far as related under eye bags is concerned basically you have 2 options, and I would lean towards a more definitive option and explain how I make that decision. When someone has mild under eye bags, we can blend the appearance with the adjacent area called the tear trough with injectable filler. We use a material called hyaluronic acid or in a trade name Juvederm or Restylane to fill that tear trough area. In some situations, we also use platelet-rich plasma (PRP) to help the skin quality and further improve the shadow if there is any issue with dark circles that make the under eyes look worse. In those situations, injectables are an option. Injectables do need to be repeated, so that’s part of the choice. Just in the first impression with your photos I would likely recommend something called the transconjunctival blepharoplasty. It’s similar in a way to the upper eyelid surgery you had in the past with the exception that it doesn’t involve any incision. This is a procedure where we remove and sculpt the fat causing the eye bags from the  inside of the eyelid under local anesthesia with LITE™ sedation, so general anesthesia isn’t used. The appeal to this approach is it’s a definitive procedure, so once it is done you don’t have to do anything to maintain it, unless you have a lot of sun exposure, or smoke, or have other issues related to the skin, but that’s a different topic all together.

You may want to meet with a doctor and discuss how to more definitively treat this area, but understand it wasn’t necessarily related to surgery. If there is a question about hormones and other issues, meet with the doctor and have that checked out. I hope that was helpful, I wish you the best of luck and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Puffy lower eyelids after Asian blepharoplasty?

It is unlikely that your lower eyelid puffiness is related to your Asian blepharoplaty. You may benefit from lower blepharoplasty.

Eric In Choe, MD
New York Plastic Surgeon
4.6 out of 5 stars 49 reviews

Likely not related to Asian eyelid surgery

It's no related.  It's more likely just your genetic an anatomical makeup.  You may be able to remove the lower eyelid bags via a transconjunctival approach or use filler or fat transfer to help.  Whatever you do to the lower eyelids surgically be conservative.
Chase Lay MDAsian eyelid surgery specialist

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 72 reviews

Eye bags in 20s

The eye bags are unrelated to your double eyelid surgery and can be improved with a transconjunctival lower blepharoplasty procedure. In Caucasian patients, mild eye bags in patients in their 20s and 30s can sometimes be camoflaged with filler injections, but the increase in cheek fullness from this procedure is not ideally suited to asian patients. Surgery is your best option.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 147 reviews

Eye bag

It looks like you have fat herniation on lower lids. Only being 20 years old ,I suggest to remove eye bag through conjunctiva without creating any incision on the skin. 
Good Luck

Andrew Choi, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 8 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.