Pouches in the corner of the upper eye lid. Treatment options? (Photo)

Question

I have visible pouches in the corners of my eyes for the last two years. My eye lids are heavy as well but the pouches are especially noticeable. I am 49 y.o smoker, don't really have any deep wrinkles yet, some jowls sagging that's in my family. Is there a non surgical option for removing these pouches or Blepharoplasty is the only effective option? Sorry for ugly pictures. Thank you.

Parker A. Velargo, MD, FACS · Answer

Your photos demonstrate the issue at hand perfectly.  The "pouches" are actually small collections of fat that used to live further back in the eye socket when you were younger.  You also have some extra skin in your upper lids.  These things generally have a genetic component.  The problem is easily corrected with a small incision placed in your upper eyelid crease for optimal scar camouflage.  The excess skin is removed and the fat pocket is also removed.  The procedure can be performed under local anesthesia with oral medications or under general anesthesia depending on doctor/ your preference.  It is a brief operation and healing time is usually 1-2 weeks though some swelling may remain longer.  In my opinion, there are not any non-surgical options for addressing loose skin and excess fat in the eyelids.  Smoking will delay the healing process, so if you can quit (at least for a few weeks before and after surgery), it would be preferable.  I wish you well!

Rob Winterton, MPhil, FRCS(Plast) · Answer

Thanks for sending in your photos! It is quite difficult to see from the images, but from your description you have excess skin and herniated fat in the upper lids. This is a common finding, and may progress over time. Botox to the forehead may lift the brows and can hide the appearance, but you could also consider surgery to remove the excess skin and fat. Upper blepharoplasty is usually a simple procedure that is carried out under local anaesthetic as a day case. Good luck!

Larry S. Nichter, MD, MS, FACS · Answer

Thanks for submitting your photos which show a prominent medial fat pad in the corner of your eye. This can be reduced as an office procedure under local anesthesia. Upper Eyelid Fat Pad Reduction

Andrew Miller, MD · Answer

I can understand the hesitation about any surgery on the face, but an upper eyelid procedure is the only way to treat the excess fat and skin. This procedure can be done while your are awake so you don't have to worry about anesthesia. The incision goes in your natural eyelid crease so you shouldn't see any scarring. The recovery is easy and it usually doesn't hurt. It's a great procedure that gives immediate long term results. Be sure to see an eyelid specialist when considering surgery.

Jamil Asaria, MD · Answer

You are a wonderful candidate for upper blepharoplasty. I believe in a conservative approach--too much fat should not be taken out to prevent a hollowed out look. There really isn't any non surgical solution, however, upper blepharoplasty is very straightforward and can be done under a local anesthetic.I hope that helps.Best wishes,-Dr. Asaria

Scott W. Vann, MD, FACS · Answer

Your eyelid heaviness and medial fat pad are very common, and the two problems that patients voice when they see me for a upper blepharoplasty. I know of no nonsurgical treatments that will resolve either of these issues. This is a short procedure done with local only or local with sedation. Good luck.

Michael Kreidstein, MD, FRCS(C) · Answer

Surgery is really the only good option to consider.  The excess fat in your upper lids could be removed in 20 minutes under local anesthetic.

Robert W. Sheffield, MD · Answer

Thankyou for your question and no, your pictures are awesome! As for your question,these puffy pouches are essentially tiny fat collections. Extra skin can alsobe observed based on the photos that you have provided. These issues can becorrected by making a tiny incision on the crease of your upper eyelid toreduce scarring or at the least hide it if it forms. Both the extra skin andfats can be removed this way. The procedure for these issues are brief andhealing can be observed in a couple of weeks. That said, surgery after effectscan stay longer. With my patients, I often notify them that full and completehealing can be observed after 3 months. 
Inmy opinion, issues like these are best treated surgically as lasers andchemical peels are only suggested for minor issues like fine wrinkles. Excessfat or skin are best managed with a surgery. If you are to undergo these, youmay want to start steering clear from smoking as this can prolong healing. Itwould be advisable to quit a few weeks prior surgery.

Kristin J. Tarbet, MD, FACS · Answer

Hello, thank you for your photos. I am glad you are looking for non-surgical options. At this time, you do not look medically significant for an upper lid blepharoplasty, and I would not recommend surgery at this time, as smoking can lead to complications.
I recommend two non-surgical considerations for both your (1) upper eyelids, and your (2) jowls.
1) Botox or Xeomin injections to lift your brows and thus upper eyelid tissue.
2) Cheek filler (such as Radiesse or Juvederm Voluma) which will in turn lift your minor jowls.  If your jowls are moderate, you might benefit from additional filler in that area.
If you consider future removal of your upper lid fat pads / tissue, you could consider cosmetic surgery, after you have quit smoking.
I recommend you visit a local board certified oculofacial injector. 
Best, Kristin Tarbet, MD, FACS

Barry L. Eppley, MD, DMD · Answer

The pouches in the inner areas of your upper eyelids is herniated orbital fat. It can only be removed by surgery. This can be done alone or combined with skin removal for a more rejuvenative effect.

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