What are my options for eye bag removal/eyelid surgery that I've had forever? (Photos)

Question

Have had my under eyebags forever. Even if I get enough sleep/hydrate well and keep stress levels low. Eyebags won’t go. Would like to understand potential options for eyebag removal.

Thomas A. Mustoe, MD, FACS · Answer

The cause of your “bags” is orbital fat that is bulging accentuated by a tear trough or valley at the border between orbital fat and cheek fat .  Your appearance is worsened by having a relatively flat cheekbone with a shallow orbit.  An absolutely optimal result Would be to lift the midface (cheek complex combined with trans conjuctival lower blepharoplasty and fat grafting g to the cheek.  However a lower lid blepharoplasty by itself combined with transfer to the valley.

Nima Shemirani, MD · Answer

Hi @lucern. Thank you for sending your photos. I would recommend a lower lid blepharoplasty. Best of luck to you!

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Donn R. Chatham, MD · Answer

Very often our eyelid anatomy is a combination of our heredity, bone structure and age. Lower eyelids can become 'baggy' when orbital fat begins to come forward, usually in our adult years. But bone structure of the midface/cheek can exacerbate this. So lower eyelid surgery can be helpful to reduce the unwanted fat, but midface support using injectible fillers and possibly surgical implants, is often needed as well. 'Caution' is the friend of 'treatment'.

Gurkan Kayabasoglu, MD · Answer

There is not only a problem with your lower eyelid, your eyebrows are very seriously drooping. There is excess on your upper eyelids. These are even more serious than your lower eyelid. But you should know that if you have your eyelid done without correcting your eyebrows, your result will be disappointing. In our eyelid surgery philosophy, the eyebrow is already a combination of upper and lower eye. It is not enough to remove your fat bags, transposing them is the best option. Otherwise, you will live with hollow eye syndrome when you get older. You can also book an online consultation and discuss your problems with me. With all respect.

Sam Speron, MD, FACS · Answer

This is a common question.  Horizontal eyelid wrinkles and sogginess can be corrected with blepharoplasty or cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

A mini facelift or midface lift is another great option for many people to correct malar bags and other signs of aging around the eyelids. The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day, you can shower the next day, there are no scars behind the ears and you can wear your hair up anytime and most patients take no pain medicine. There are never any guarantees of course with any procedure whether it is surgical or nonsurgical in nature.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

Marc Polacco, MD · Answer

Thank you for your question. Based on your photos, there are two components contributing to your concerns. One is the lower eyelid fat pad which causes puffiness. This is treated surgically, and the skin can be tightened slightly at the same time. Laser resurfacing will also be helpful for tightening the skin. I'd recommend both treatments in combination for the best result. 
-Dr. P

Jeffrey Lisiecki, MD · Answer

Based on your photos, you are a great candidate for lower blepharoplasty and fat grafting to the cheeks and undereyes. I perform a transconjunctival lower blepharoplasty--through an incision on the inside of your lower eyelid, I remove the bulging fat, and then I tighten the skin and support structures of the lower eyelid to smooth out the bags. I would also graft a little bit of fat to your cheeks and undereyes for support and to smooth the transition from cheek to eyelid. The key to doing this in men is to not overdo any step of this process, to fix the problem and support your eyelids but keep you looking masculine and looking like yourself.

Nelson Lee Novick, MD · Answer

Yes, you read right. The upper cheek region is a very important support for the under eye region, and when there is volume deficit in this region (either from aging or genetics, etc.), there is the almost inevitable development of hollowness, tear trough formation and wrinkling. The skillful use of an appropriately volumizing/lifting HA filler injected properly into the upper cheek region can resupply the volume and support necessary to significantly and nonsurgically improve the under eye region and the cheeks at the same time. When performed by experienced hands, the results are typically on-the-spot,  elicit an immediate "Wow!" response, and engender little to no significant downtime. Surgery to tighten the skin ma even result in  emphasizing the hollowness under the eyes, does nothing for addressing the critical volume deficit issue, is expensive and engenders real post-treatment downtime. Make sure to consult with an experienced, board certified cosmetic dermatologist and be sure to ask to see his/her personal befores and afters before agreeing to proceed. Best of luck.

Renata Khelemsky, MD · Answer

Lower eyelid surgery is an excellent solution for your condition. I would recommend having lower eyelid fat repositioning blepharoplasty where the fat is preserved under the eye to avoid getting hollows and a more tired appearance after surgery. The fat repositioning technique allows the undereye to appear smooth next to the cheek. Additionally, depending on your physical exam, skin and muscle may be tightening, or at times, trimmed, to remove very lax undereye skin. This is a delicate area, so ensure you choose a surgeon with extensive experience in facial surgery, especially lower eyelids!

What are my options for eye bag removal/eyelid surgery that I've had forever? (Photos)

Answers (14)

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