Eye Bag Surgery (Lower Lid Blepharoplasty)

Your eyes are often the first thing that people notice about you, and are an important aspect of your overall appearance. Young eyelid skin is smooth, but over time, the eyelid skin stretches, the fat bulges, and the muscles weaken.

Your eyes are often the first thing that people notice about you, and are an important aspect of your overall appearance. Young eyelid skin is smooth, but over time, the eyelid skin stretches, the fat bulges, and the muscles weaken.

In some people, the fat does not bulge, but shrinks, giving the eye a prematurely aged appearance by increasing the hollows below the eye, giving the appearance of dark circles.

Eye Bag Surgery (Lower Lid Blepharoplasty)

Age, hereditary factors, sun exposure, smoking all contribute to this process. People who have suffered from thyroid eye disease or “eye rubbers” (due to allergic eye problems), can also present with loose lower lid skin and puffiness.

Some people have a collection of fluid in the layers of the skin (called “festoons”). These are very difficult to treat, and do not always respond to standard blepharoplasty surgery.

Loose or baggy lids detract from your overall appearance and make you look tired or older.

How can sunken lower lids or “dark circles” be treated?

Fillers

Fillers like fat or hyaluronic acid gel can be used judiciously in improving the hollow appearance of the lower lids. Please refer to the section on fillers.

How can saggy lower lid skin and fat prolapse be treated?

Blepharoplasty

Surgery to improve the appearance of the eyelids is called blepharoplasty. The goal of blepharoplasty is to give the eyes a more youthful look by removing excess skin, bulging fat and lax muscle from the lower lids.

Fat in the lower lid can be removed or repositioned through a cut hidden in the natural lower lid crease or on the inner surface of the lid (transconjunctival blepharoplasty). The excess skin and muscle can be removed or the skin can be treated by Laser resurfacing or a chemical peel, to tighten the lower lid skin.

What are the potential risks & complication of eye bag surgery?

The risks of surgery include

  1. Infection: this is very rare, occasionally the stitches may have an infective or inflammatory response, which settles with oral and topical antibiotics.
  2. Scarring (generally hidden in the skin fold or inner part of lid). Normally stitches are visible for the first week, then, when they are removed, a faint scar is visible. The scar may seem a bit thickened & red for 6 to 12 weeks, becoming almost invisible after that period. Not every scar heals equally well. A thickened or reddened scar can be improved with silicone scar remodeling gel, but the treatment needs to be continues for months to have a good result.
  3. Large bruise or haematoma. This is minimised by avoiding heavy exercise for 2 weeks after surgery, stopping aspirin and other anticoagulants (if safe so to do) 2 weeks pre operatively, and regular use of ice packs. A haematoma may mean you have to go back into theatre to have the blood clot evacuated and then be re-stitched with the risk of a worse scar.
  4. Theoretical risk to vision. Any eyelid surgery carries the risk that an undiagnosed infection or bleed could damage the optic nerve. This is so rare that in comparison a normal car journey is a much greater risk to your vision.
  5. “Hollow” appearance: this is rare, but can occur, due to removal of excess fat.
  6. Temporary poor blink, generally blink returns to normal within 12 weeks.
  7. Sagging of the lower lid : this can happen at the due to scarring between the layers of the lid or inadvertent removal of excess skin. This can alter the shape of the lower lid and cause a watery eye. Occasionally this may require corrective surgery with either a skin flap/graft or a midface lift.
  8. Change in outer angle of lid. Often the outer corner of the lower lid needs to be supported when performing a blepharoplasty. This can occasionally heal without maintaining the sharp outer angle of the eyelid, giving a rounded appearance, which is often challenging to rectify.