What can one do for bags under the eyes? There are three different approaches to correcting lower bags under the eyes:
- Lower blepharoplasty
- Injectable fillers
- Fat Injections
I now consider Fat Injections as the technique which solves the problem the best.
Removing lower eye bags with a lower blepharoplasty
For many years, patients would come to me asking to remove the bags under the eyelids, saying the bags made them look old and tired. I usually recommended a standard blepharoplasty or Eye lift. That involves making an incision right under the eyelashes, lifting skin and the muscle that is right under the skin. I would then remove the fat. It was the standard solution but it had several drawbacks.
For one, the area under the eyelids would sometimes appear hollow. Sometimes the line separating the “bag” from the cheek skin would become a deep trough, highlighting the emptiness under the eyeball. On certain patients, especially those with shallow cheekbones the lower eyelid could hang lower, showing the white under the iris (the colored part of the eye). In some cases, the lid would pull away from the eyeball, causing excessive tearing and dryness.
For that reason, I started doing what is called subconjunctival blepharoplasty, where the incision is made on the tissue inside the eyelid, leaving the skin and muscles intact. I would then do a peel or laser to take care of the wrinkles. This solved the problems related to the lower eyelid, but did not help the hollowness under the eye. I accepted this, because it was the best technique we had.
Using fillers for lower eye bags
As Restylane and other Facial fillers gained popularity, I started injecting fillers in the trough under the eyelid on young patients. It helped camouflage or disguise the bag under the eyelid, and I started using this approach more and more. But what really struck me was the “WOW” moment after the patients saw themselves in the mirror. It changed their whole look! If you read my post on where people focus on the face (saccadic eye movements), you understand why a little thing like a smooth contour under the eyelids has such a big impact. As the saying goes, “The eyes have it”.
Fat injections for lower eyelid bags
More recently, a patient who had had a Facelift and blepharoplasty several years ago by another surgeon came to me requesting a “revision” facelift.
For correction of lower eyelid bags, I now prefer fat injections
Since traditional facelifts do not address the area under the eyelids, and the area under the eyelids appeared hollow,
I thought that pulling again on her skin would make her look worse, tight and drawn. When I proposed Fat injections under the eyelid, she was not interested. To show her how this could improve her look, I injected saline in the upper cheeks and under the eyelids. The purpose of this was to imitate what real fat injections could do.
Talk about a “WOW” moment! After seeing the results that the saline injections produced (temporary), she agreed to the fat injection surgery right away. She had a remarkable result for a procedure done under local anesthesia, at a fraction of the cost any of the other surgical alternatives. This was a “big bang for the buck”.