Lower eyelid “bags” and “dark circles” are common patient complaints. They make the face look more tired and older. “Bags” or “dark circles” are simply caused by fullness or relative fullness of the lower eyelids and/or hollowness or relative hollowness (tear troughs) below the lower eyelids, depending on the individual. The factors involved are genetics and aging. During the aging process, the lower eyelid fat pads become prominent (orbital fat herniation), causing relative fullness of the lower eyelids. Moreover, there is fat deflation and descent of the midface/cheeks which results in relative hollowness below the lower eyelids. Some have congenital hollowness below the lower eyelids. One other important aging change is that the skin of the lower eyelids loses elasticity and stretches, resulting in ‘excess’ lower eyelid skin and wrinkles.

There are various nonsurgical and surgical treatment options for lower eyelid “bags” and “dark circles” and lower eyelid wrinkles, depending on the variables involved in each individual, hence each person needs an individualized treatment plan.

In lower eyelid bags surgery, fat in the lower eyelids can be removed or repositioned through a scar-less incision hidden on the inner surface of the eyelid (transconjunctival blepharoplasty), thereby creating a more smooth, natural, rested appearance to the eyes.  Dr Taban also uses special technique to remove hidden fat of the lower eyelid. Please click on this link for an article published by Dr Taban, entitled “Upper Eyelid Approach to Lower Blepharoplasty”.

Laser resurfacing or a chemical peel can be performed at the same time to smooth and tighten the loose lower eyelid skin. Alternatively, incision can be made just below the eyelashes (infraciliary incision) and excess skin removed (skin pinch technique). (Please click on this link for an article published by Dr Taban on this technique: “Lower Blepharoplasty with Skin Pinch”.) A special technique, named orbicularis plication, may also be performed to tighten the underlying muscle in the lower eyelid, which helps with excess skin in the lower eyelid and festoons (bags in upper cheek area). Transconjunctival blepharoplasty results in a natural contour to the lower eyelids. The transcutaneous approach (through skin) has increased risk of altering (rounding) the shape of the eye and can be unnatural.

Lower blepharoplasty for eyelid bags can be combined with concurrently with other procedures, including upper blepharoplasty (“Quad-blepharoplasty”), brow lift, canthoplasty, midface lift, facelift, fat injections, and laser skin resurfacing.

A nonsurgical treatment is to fill the relative hollowness below the “fullness”, thereby camouflaging the “bags”. Young patients actually don’t have fatty prominence; rather have congenital hollowness below the eyelids (tear troughs) and they are ideal for injectable fillers (Restylane).

Who is a Candidate?

  • If you have excessive, sagging or wrinkled lower eyelid skin.
  • If you have puffy pouches of fat in the lower eyelids that create a tired or aged appearance.

Intended Result

  • A more youthful and rested appearance of the eyes.

Procedure Description

  • The operation is usually done on an outpatient basis under local anesthesia alone or conscious sedation.
  • The incision for the lower eyelids is usually inside the lower lids, avoiding external incisions and scar (transconjunctival), unless excess skin needs to be removed too in which an incision just below the lashes is also made. (Alternatively, chemical peel or laser resurfacing can be done to tighten the skin.)
  • If there is significant “laxity” of the lower eyelid, a canthoplasty or tightening procedure may be done at the same time.

Recuperation and Healing

  • The transconjunctival incision does not require any sutures. If an incision was made below the lashes, then absorbable sutures were placed.
  • Bruising and swelling usually subside within 7-10 days.
  • Eye makeup may be used following healing of the incision.
  • Contact lenses can be worn when comfortable (usually after 7-10 days)
quad-bleph endoscopic brow lift. chemical peel.

Before (left) and 3-months after (right) quad-blepharoplasty, endoscopic brow lift, chemical peel

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Before (left) and 3-months after (right) transconjunctival lower blepharoplasty with fat repositioning

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Before (left) and 6 weeks after (right) lower transconjuctival blepharoplasty.

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