Eye Bags and Mid-face

Photo of man showing eye bags

Eye Bags

Each eye socket contains fat that cushions the eyeball.  When the fat bulges out of the sockets (pseudo-herniation), it causes eye bags.  So removal of eye bags means simply removing the fat? It is not so simple.  There are other signs of ageing that need to be taken care of.  The time-honoured method is to surgically excise the fat.  There are now laser and heat-based machines that claim to be able to remove eye bags.  Some people are concerned about injury to the eye and surrounding structures from these machines.  There are also concerns about how effective they are.


Tear Trough Deformity

As one ages, the soft tissue of the cheek will sag to a lower position.  The bony socket of the eye is no longer covered with this tissue and this creates the tear trough deformity (red arrows). Therefore, just removing the fat of the eye bags will not change this appearance.  Even if it is possible to burn off all the fat in the eye bags without damaging the eye, there will still be a groove below the eye bags.  The next decision to make is whether to camouflage the groove or lift the cheek back to its original position

Photo of man with eye bags and tear trough deformity

"Scarless" Lower Lid Blepharoplasty

A very popular procedure that is widely advertised sells is the Trans-conjunctival Blepharoplasty.  Here is a YouTube video that describes the procedure.  The incision is made inside the eye lid and this appealing because everyone assumes that is is safe since there is no external incision.   The fat of the eye bag is not removed.  Instead it is pulled down to camouflage the tear trough.  


The trans-conjuctival approach was very popular when it was first described but, as with many new methods, it’s disadvantages became evident after some time.  Here is a YouTube video that explains the problem. 


Most people are not willing to pay for this procedure to be done under general anaesthesia.  This means that the patient will be, at least partially awake and has to be comfortable with the surgeon cutting and working INSIDE the eyelid.   


The other method is the transcutaneous or sub-ciliary approach, where the cut is make 2mm below the eyelash margin on the outside of the eye lid.  Look at your friends who have had this procedure and see whether there really is a visible incision after it heals.  It is virtually “scarless” and this approach allows excess skin to be removed. It is less frightening to have the surgeon working from the outside of your eye.  


What sounds nice online is not always as good as it sounds. 


Photo of woman with prominent laugh lines

Eye Bags & the Mid-Face

This is the typical appearance of someone with eye bags.  There is loose skin of the lower eyelid.  The sagging cheeks create prominent “laugh lines”.  Pulling down the fat from the eye bag makes the upper cheek look a but more puffy.  It is like spreading out the fat.  What about the loose skin and the laugh lines? Some eye bags are still better corrected by an external incision because it allows excess skin and fat to be removed and sagging cheeks to be lifted.  It is scarless and it is less frightening than being awake while some is working inside the eye lid.