Options for Minimizing Remaining Eye Bags After Blepharoplasty?

I am a young-looking 55 year old. I had lower Blepharoplasty over 3 months ago to correct what I thought were eyebags, but I'm not happy with the results. I still have the eyebags, and now I have undereye wrinkles, and one of my eyes appears bigger (I know some asymmetry is normal, but it wasn't noticeable before).

After doing a lot of reading, I now realize that the "bags" are probably malar mounds or festoons. My doctor is recommending a chemical peel to minimize the "bags" rather than any surgical revision. How does a chemical peel compare with the various laser options? What are my other surgical and non-surgical options, and should I go to an ocular plastic surgeon at this point?

Doctor Answers 16

Experienced facial plastic surgeon or oculoplastic surgeon

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If the bags underneath your eyes are malar edema or festoons, this is not addressed with a blepharoplasty. Chemical peels and laser resurfacing will not minimize those bags. A mid facelift may help. If they are severe, direct excision can be performed. An oculoplastic or an experienced facial plastic surgeon could help with this problem. Under eye wrinkles can be addressed by removing a conservative amount of skin in the lower lids at the lash line. This has to be a conservative removal for fear of changing the shape of the eye. This is typically closed with Histocryl tissue glue.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Lower Blepharoplasty

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Lower eyelid surgery (Blepharoplasty) is one of the more difficult operations. I have seen the technique of various "specialists" over the years and I don't think it matters whether your surgeon is a plastic surgeon, facial plastic surgeon, oculo plastic surgeon or cosmetic surgeon - but it matters if your surgeon is current with his or her knowledge for treating the lower eyelid. The general trend in lower blepharoplasty is toward conservation of the lower eyelid skin, preservation of lower orbital fat, avoiding tension on the lower lid, performing a canthopexy or canthoplasty and filling the tear-trough depression.

It sounds like you may have some of the common problems related to lower eyelid surgery. Asymmetry in the eye size may be do to poor lateral canthal support, requiring canthopexy or canthoplasty. The wrinkles under the eyes could be due to inadequate treatment of the skin, superficial laser resurfacing works well on skin with fine wrinkles. The bags could be due to inadequate treatment of the orbital septum, tear trough, and infra-orbital rim - cheek junction. Remember, over resection of the inferior orbital fat can lead to a hollow, sunken appearance over time and should be avoided.

Daniel Reichner, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 51 reviews

Festoons are hard to treat

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Dear Sueesquisite,

Festoons or malar bags, if that is the problem, are very difficult to treat. I have tried deep laser resurfacing and deep Infrared skin tightening technology and been disappointed with the results.

I have had good luck wiith a lateral eye/cheek lift performed through a lateral extension of the lower blepharoplasty incision.

During this procedure I elevate the lateral canthus (the tendon that supports the lower eyelid) and the lateral orbicularis oculi muscle, both of which pull the lateral (side) lower eyelid skin and upper cheek skin (the festoon) up.

This is tricky surgery and your doctor will have to be comfortable with the technique.

You mentioned an asymetry of the eyes. it is likely that the lower blepharoplasty has weakenbd the support of the lower lid, exposing more of one of your eyes than the other.

The benefit of the above technique is that the lid support can be strengthened and hopefully lower eyelid symetry improved.

Be sure to ask the right questions and insist on answers that make sense to you.

I do not think a chemical peel will help. I am also concerned that if the peel goes too deep, it could put further downward pressure on the eyelid and expose more of your eyes-a sad eyed look or ectropion.

Malar Festoons

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The bags that you describe are probably malar festoons. These lesions aren't adequately treated with standard blepharoplasty because they tend to extend beyond the eyelids. Furthermore, both lasers and chemical peels have no impact upon large festoons.

A variety of treatment options are available for treating this problem. These include midface lifts and direct excision. The treatment chosen will depend upon the specific anatomic deformity.

If you're considering treatment of this condition, it's important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Post op festoons

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Thank you for sharing your question, because that is not an uncommon complaint. The surgeon is responsible to point out this feature to the patient prior to performing blepharoplasty and warn that they will persist after surgery. There are a few options to treat them, but excision seems to be the preferred treatment. An experience eyelid specialist is capable of correctly diagnosing the problem and discussing how to treat it. I hope this is helpful for those with similar issues.

Options to minimize Eye Bags

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With today's technology there are new procedures that can assist you with your concerns. There are several different treatments that can help soften/minimize the lines and bags and lines if needed. Initially we would suggest you go in for a consultation with your original physician who performed the procedure. Talk with him/her about your concerns so they can help you make the best informed decision  Be sure to ask any and all questions you have until you are satisfied/comfortable with the treatment you and your physician has decided on.



Edward E. Dickerson, IV, MD
Fayetteville Facial Plastic Surgeon
4.7 out of 5 stars 127 reviews

A chemical peel will not help malar bags

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As we age, many changes take place around the lower eyelid. The orbital fat can bulge forward and the fat overlying the bony rim can diminish causing a groove. Also, skin and soft tissue can sag over the cheekbone area causing malar bags. These bags can be extremely difficult to remove. Standard lower lid bleph does not help, and even an extended procedure onto the cheek is not without more risk and possibly a limited result.

I feel the best way to smooth under the eye along with eyelid surgery is fat grafting. Harvested fat can be placed in the groove under the eye as well as the cheek area building up a great result over time that is also natural with minimal risk and downtime. Good luck.

Dr. Miller

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 reviews

You might need revision surgery in the future

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A chemical peel in general is not the best option for treating malar bags or festoons. Unfortunately, they are notoriously difficult to treat in general. Usually, the best chance of diminishing them is with surgery - some form of an extended lower lid blepharoplasty. At this point, I think, I would talk to a couple of other doctors, perhaps including an oculoplastic surgeon about your options.

Since it had been only three months since your surgery, it would be best to wait for resudual swelling to resolve before doing anything, but you can start thinking about your optionsn and it would be helpful to see you in person to evaluate things better. A chemical peel or a laser resurfacing procedure might help with the lines, but will not do much for malar festoons. A revision surgery in the future might be a better option for you.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Lots of options-stick with your surgeon

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There are limitations to what can be accomplished with a blepharoplasty, and it sounds like what you are describing is an issue in the upper cheek area where it transitions into the eyelid. A chemical peel can be very helpful with this. Laser resurfacing would probably do more but there is more downtime and it is not as easy to do under local or topical anesthesia, as would a chemical peel. Often the addition of volume can help to fill in the transition areas, with a dermal filler like Perlane or Juvederm. It may seem counterintuitive to add volume back in but it wouldn't be into the area where bags were removed.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

There is no simple answer to this problem

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I am in the business of fixing other surgeon's eyelid surgery results. Flat out, it is impossible to definitively answer your question without a personal consultation. For the right patient, a chemical peel can be helpful for addressing malar festoons and reducing or eliminating lower eyelid wrinkles. I often do just a lower eyelid peel without surgery to flatten the herniating orbital fat and reduce eyelid wrinkles. The key is proper patient selection. Generally the people who do the best with this approach have a very light (but not too light) complexion and reasonable skin thickness.

However, you are only 3 months out from your surgery. I would advise that you should heal for another 3-6 months before doing anything else. I would caution you regarding having the same individual revise your result. It is a simple test really. If you had ultimate confidence in your surgeon, it is not likely that you would be on this board looking for answers. The book "Blink" tells us to trust our first impressions. You are best served seeking out a truly experienced eyelid surgeon in your area or traveling to seen someone who specialized in fixing these types of problems. Your surgeon may be great at noses or breast surgery but your brain is questioning your confidence in this person as an eyelid surgeon. Please listen to your gut feeling.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.