Will I Likely Get a Good Result from Eye Bag Surgery?

Hello, I have terrible eye bags that are hereditary and are getting worse over time. In photos, you can hardly see my eyes. But I don't think the bags are the result of fat pads, at least not entirely. When I am not smiling, the bags are barely noticeable. It's only when I smile that they look horrible, and I think it's a matter of excess skin that bunches up. I don't know how much you can tell from a photo, but here's one that shows what I mean. I'm a bit worried about the horror stories about people who get hollowed under-eyes or rounding of the bottom eyelid, and I'm wondering if there are particular types of people who surgery works better on than others. Thanks for any advice.

Doctor Answers 7

Lower eyelid fat herniations vs muscle roll

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When eye bags are present when the patient is not smiling or squinting, and disappear when they squint/smile, these bags are usually due to fat herniations. In that case, fat reduction procedures such as transconjunctival blepharoplasty or fat repositioning blepharoplasties can help.

Eye bags that are absent in repose but occur during animation indicate a muscle roll problem often combined with hollowness below the eye. This problem is actually made much worse by removing more lower eyelid fat. It appears that is your problem. Most patients are fine with Botox injections to focally reduce the activity of the pretarsal orbicularis and the lateral orbicularis fibers. In patients with a severe version of the problem, especially when the lower eyelid skin bunches up and sbhas become lax, we can reduce the pretarsal orbicularis and augment volume in the infraorbital/tear trough region as with a muscle-tailoring LUSIC cheeklift.

That said, it is difficult to tell from a single, animated picture.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

You don't need surgery

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If your eyes look good when you are not animating them, then you don't need any surgery. What you are seeing in your photo is excessive orbicularis oculi muscle function when you smile or squint that makes it appear as though you have bags, fullness and extra skin in the lower lid.

Surgery is primarily indicated for what you see at rest such as bulging fat bags. Animation artifacts like yours are best treated with conservatively administered Botox injections by an experienced physician to weaken the effect of the overactive muscles.

Bunching and excess skin

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I am going to take the less popular position and say yes, surgery may be the answer.  speaking in general terms, if there is no fat pad herniating them removal of fat is not indicated. if there is no excess skin then no skin removal is needed, if the skin texture is good, then a peel or laser is not indicated, if you do not have an orbicularis oculi bulge, then resection of a infratarsal strip of muscle is not indicated. So, looking at this one picture and taking into account what you have told us about your problem, I would do a limited skin flap with strip resection of OO muscle in the infratarsal position and judicious removal of skin IF necessary.  a staged peel may be helpful as well.  the problem I have with botox is it will indiscriminately weaken the muscle and may lead to the appearance of excess skin and even impair function of the lower lid.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

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Non-surgical Approach for Eyelid Bags

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Judging from your photo, you do not appear to have eyelid fat. The bunching of your skin with smiling appears o be due to your hyperactive muscle of the lower eyelid. Surgery is not used to treat this problem. In some patients, I have had good success with botox injections to reduce the overactivity of the muscle. If you are concerned about skin laxity of fine lines lines under the eyes, I would also recommend a chemical peel.

Anita Mandal, MD
Palm Beach Facial Plastic Surgeon

Agree with Non-Surgical Approach

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You have been given excellent advice here and I would only like to add that given your description of your eyes that a non-surgical approach should be considered.

Some options could include:
1. Chemical peel or laser resurfacing of the skin around the eyes
2. Botox injections to improve wrinkles and appearance of eyes
3. Fat injections to help contour the eye and cheek areas

These are still procedures and do require recovery time and each has their risks as well but they are successful techniques that could potentially be of help to you.

Take care,

Dr. Kamran Jafri

Kamran Jafri, MD
New York Facial Plastic Surgeon

Good results from eye bag surgery

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 The decision to perform eyelid surgery is made at rest, not upon animation. With animation and smiling the orbicularis oculi muscle contracts, bunches up the skin and creates wrinkles and crows feet. It's impossible to determine whether or not there are fatty deposits located underneath the skin and muscle when animating. For many examples of  blepharoplasty, please see the link below to our eyelid surgery photo gallery

Candidacy for Blepharoplasty: Are you a good candidate for eyelid surgery

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Lower eyelid surgery is performed to correct one of two things; excessive skin or excessive fat beneath the skin. This is best visualized with the eyes at rest rather than when squinting, as in your picture.

Candidacy for the procedure is based on several criteria:

  • Redundancy of skin in the lower eyelid
  • Quality of skin in the lower eyelid
  • Orbital fat protruding through the skin

There are specific risks associated with the surgery. Experience is particularly important in obtaining a good result.

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.