Trans-conjunctival Eye Bag Removal or Non-incisional Laser Eyebag Procedure?

This is a follow up of my previous question. I actually had restylane injection done recently, but the result wasnt what I had hoped for hence the decision for the surgery. I've consulted a plastic surgeon & was told I'd need to have the fillers dissolved first prior the surgery, & then have restylane injection again post operation to fill up the hollowness. May I ask if there is actually a direct way which I wouldn't need the post op restylane injection or is it the only way for best results?

Doctor Answers 7

Restylane under the eyes

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Dear ketvi,

  1. Everyone does lower eyelid surgery differently and in my practice, I use fat injections after the fat from the lower eyelids have been removed
  2. Although this sounds a little odd, it is the location of the fat that gives you the tired look
  3. When I inject the fat, it acts like Restylane (even better) to fill in the hollows; this lasts for years and looks very natural
  4. You need to see an experienced surgeon in fat transfer for optimum results
  5. You should have it dissolved prior to surgery so we know how much to inject and fix

Best regards,

Nima Shemirani

Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Trans-conjunctival Eye Bag Removal or Non-incisional Laser Eyebag Procedure?

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Without photos or an examination, it's hard to to give a definitive recommendation.  Restylane under the eyes needs to be placed on the periosteum (covering of the bone), not under the skin like in other areas.  If it's too superficial, you can often feel lumps.  First thing to do is dissolve the Restylane and then see what the area looks like.  After that, then you can be examined to determine your options - transconjuctival bleph (only fat removed), traditional bleph, skin and fat removed, or maybe just a laser resurfacing if its just a little loose skin. I would recommend getting another option to possible get different options.

Rigo Mendoza, MD
Tampa Plastic Surgeon
4.4 out of 5 stars 40 reviews

Options for dealing with bags under the eyes

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It is hard to say without photographs and an exam.  I need to see what about your eyes is still going on and wasn't corrected by the Restylane.  

The lower eyelid is a complex area.  Most people begin to develop puffiness in the lower eyelid itself as the orbital septum weakens with time.  This allows the fat under the eye to pooch forward creating a bag.  At the same time, most people lose volume below the lower lid in the tear trough.  This high/low situation makes the lower lid bagging look much worse.  The ideal correction for this area does involve restoring volume in the tear trough (and cheek if necessary) and removing the puffiness of the lower lid (with surgery).  

Removing the Restylane may or may not be necessary, it depends on where and how the Restylane was placed.  If it was placed too superficially, then it will need to be removed.  I would consider a second consultation with another board certified facial specialist.

Michael Bowman, MD
Roanoke Facial Plastic Surgeon

You need to be carefully evaluated clinically to answer this questions about transconjunctival blepharoplasty.

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If the Restylane is distorting the anatomy of the eye bags, then dissolving it pre surgery is probably a good idea.  The eye bag fat is usually clearly visible closer to the lower eyelashes and may be able to be removed without first dissolving the Restylane.   Restylane is usually correctly placed over the infraorbital bone and can often be palpated to determine if it is fat or filler.  A doctor who is an expert in both fillers and lower eyelid surgery should be able to give you good advice. 

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Restylane in, Restylane out Eyelid Surgery

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A complete exam and evaluation would be necessary.  While the Restylane may need to be removed or dissolved in order to better  improve your lower eyelids, surgery may be performed to improve the lower eyelid contour without replacing Restylane afterwards.

Mark Berkowitz, MD
Sterling Heights Oculoplastic Surgeon
4.8 out of 5 stars 65 reviews

Lower lid issues

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Without an exam it is difficult to say what would be best for you.  Your surgeon may be correct in his analysis but I can  not comment without the exam.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

I would encourage you to seek additional opinions.

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Your plastic surgeon might be absolutely correct.  On the other hand, I seen one or two new patients a week who have had a filler service elsewhere and all they need is a bit of adjustment that the injecting doctor was not skillful enough to perform.  Good luck out there and let us know what you decide to do and how it goes.

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.