Under eye “bags” and “dark circles” are common complaints among our patients. They make the face look tired and older. Eyelid “bags” are caused by fullness or relative fullness of the bottom eyelids caused by prolapsed or herniation of the orbital fat (fat surrounding the eyeball in the eye socket). This is due to eyelid aging, but can happen in many younger individuals due to genetics. “Dark circles” are caused by relative hollowness under the eyes (below the bags) in the area of the tear troughs or orbital rim. The darkness is mostly due to a “shadow” phenomenon where the full area above the hollow area casts a dark shadow below it.
The under eye hollowness (aka tear trough deformity) could be genetic or it could be due to loss of upper cheek fat and descent (fall) of the cheeks. Another important aging change is that the skin of the bottom eyelids loses elasticity and stretches, resulting in ‘excess’ lower eyelid skin and wrinkles.
Who is a Candidate for Lower Blepharoplasty ?
- If you have puffy fat pockets (bags) in the bottom eyelids that create a tired or aged appearance.
- If you have wrinkled, saggy, loose lower eyelid skin.
- Natural looking, youthful, rested eyes.
Dr. Taban in Beverly Hills also performs corrective revision lower blepharoplasty in those patients who have had bad results or complications from prior blepharoplasty, such as post-blepharoplasty eyelid retraction, scleral show, rounding of eyes, poor eye closure (lagophthalmos) with dry eyes, etc. Please visit our website under Revision Eyelid Surgery for more details.
Lower Blepharoplasty & Eyelid Bags Surgery
There are various nonsurgical and surgical cosmetic treatment options for lower eyelid bags, dark circles, and bottom eyelid wrinkles, depending on the variables involved in each individual. Therefore, it is important for each person to have 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 in Los Angeles is an expert cosmetic blepharoplasty surgeon, who uses a special technique to reposition or redistribute the fat under the eyes to concurrently fill in the hollow area below it, called transconjunctival lower blepharoplasty with fat repositioning. This special cosmetic eyelid procedure achieves two things at the same time: 1) removes under eye fat pads; 2) fills in the hollow tear trough area (dark circles). VERY IMPORTANTLY, this procedure avoids the hollow sunken eye appearance if fat is merely removed.
The hidden transconjunctival (inside lower eyelid) incision has additional advantages: 1) the scar is hidden; 2) the incision is stitch-less with much quicker healing; 3) avoids potential damage to the orbicularis oculi muscle (responsible for closing the eye and blinking) which can cause the lower eyelids to get pulled down (eyelid retraction) with inability to close the eyes (lagophthalmos) and dry eyes.
Read Dr. Taban's abstract about Lower Blepharoplasty with Previous HA Fillers.Click to Read
Read Dr. Taban's manuscript Lower Blepharoplasty with Skin Pinch to learn more.Click to Read
Read Dr. Taban's manuscript Upper Eyelid Approach to Lower Blepharoplasty to learn more.Click to Read
Additional eyelid bags treatment options are available to address wrinkled, loose skin on the lower eyelid, if present. Laser resurfacing or a chemical peel can be performed at the same time as transconjunctival lower blepharoplasty to smooth and tighten the loose lower eyelid skin. Alternatively, incision can be made just below the eyelashes (subciliary or infraciliary incision) and excess skin removed (skin pinch technique).
A special technique, named orbicularis plication, may also be performed to tighten the underlying muscle in the bottom eyelid, which helps with excess skin in the bottom eyelid and festoons (bags in upper cheek area).
The goal of transconjunctival lower blepharoplasty (with fat repositioning, with/without skin pinch skin removal) is to create a NATURAL, smoother under eye area for a rested appearance WITHOUT causing eyelid retraction or altering (rounding) of the eye shape. A transcutaneous lower blepharoplasty is not recommended as it often results in a surgical, unnatural eye appearance and possibly dry eyes from poor eye closure and blinking.
Lower blepharoplasty for eyelid bags can be combined concurrently with other cosmetic eyelid or facial procedures, including upper blepharoplasty (“eyelid, lid Lift,” “quad-blepharoplasty”), droopy eyelid (ptosis) surgery, brow lift, canthoplasty, midface lift, facelift, fat injections, and laser skin resurfacing.
Read more about eye bags surgery from WebMD.com.
Nonsurgical Treatment of Under Eye Bags or Dark Circles
A nonsurgical treatment for under eye bags and dark circles requires filling in the relative hollowness below the “fullness” or “bags,” thereby camouflaging or hiding the eye bags. But there is a limit to how much filler can or should be injected to give natural results, without creating excessive swelling or puffiness from the filler.
In general, young patients don’t usually have under eye fatty prominence; rather, they have inherited hollowness below the eyelids (tear trough deformity) and they are ideal for injectable dermal fillers (Restylane, Belotero) in the sunken under eye area, instead of surgery (lower blepharoplasty).
What to Expect During the Procedure
Cosmetic lower blepharoplasty is performed under local anesthesia with oral sedation (similar to a dental procedure) in the office or local anesthesia with IV sedation (conscious sedation, similar to that used for colonoscopies) in an outpatient surgical center, with quick recovery. General anesthesia is not necessary and it is best avoided as it prolongs systemic recovery.
With the patient relaxed, the eyelid is numbed. The patient is able to open and close his/her eyes during the procedure with comfort, which helps the surgeon achieve the best possible results and correct any eye asymmetry, etc. The incision is made inside the lower lids (transconjunctival), avoiding external incisions and scarring, unless excess skin needs to be removed as well, in which case an incision just below the lashes is also made.
Alternatively, a chemical peel or laser resurfacing can be done to tighten the skin. If there is significant “laxity” of the bottom eyelid, canthopexy, canthoplasty or lower eyelid tightening procedures may be done at the same time to prevent drooping of lower eyelids after lower blepharoplasty.
Recuperation and Healing
The recovery process after cosmetic eye bags surgery is practically painless, with bruising/swelling of the eyelids for about 1 week. The transconjunctival incision does not require any sutures. If an incision was made below the lashes for a skin pinch, then absorbable sutures are used. The vision remains intact since no patch is necessary. Eye makeup may be worn following incision healing. Normal activities, including contact lens wear, can be resumed 1 week after the procedure.
Who Should Perform Cosmetic Lower Eyelid Blepharoplasty Surgery?
Natural results are key to any cosmetic procedure, especially when it comes to the eyes. In regards to lower eyelids, it is extremely crucial to achieve natural looking results AND avoid known complications of lower blepharoplasty (pulling down of lower eyelid or eyelid retraction, sclera show, inability to close the eyes, scarring, etc).
“Prevention is the best treatment,” therefore, avoidance of these complications is critical. Dr. Taban in Santa Barbara is an oculoplastic specialist (reconstructive and cosmetic eyelid plastic surgeon), with expertise in cosmetic blepharoplasty and revision blepharoplasty surgery. Dr. Taban in Los Angeles uses minimal invasive approach (transconjunctival incision +/- skin pinch) with fat preservation to give best possible, natural result. He is double board certified by American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), American Board of Ophthalmology (ABO/AAO), and a diplomat of American Board of Cosmetic Surgery (ABCS).
During your consultation for blepharoplasty with Dr. Taban in Beverly Hills/Los Angeles or Santa Barbara, he will evaluate your eyes and face, and come up with detailed surgical plan, customized to each individual patient, depending on their exact anatomy/problem and desired goals. Dr. Taban in Los Angeles will discuss any other complimentary cosmetic eyelid procedures, such as upper blepharoplasty (eyelid lift), droopy eyelid (ptosis) surgery, canthoplasty, brow lift, and eyelid fat injection, that may be performed at the same time to achieve the best NATURAL looking, youthful cosmetic result.
Young woman, complained of looking tired due to under eye puffiness and dark circles. She underwent scarless transconjunctival lower blepharoplasty with eye fat repositioning. Her preop, surgery, and 1 month postop are shown.
29 year old woman complaining of looking tired due to dark circles and puffiness underwent Scarless Procedure — a Transconjunctival Lower Blepharoplasty — under local anesthesia to remove under eye fat bags.
Video showing removal of hyaluronic acid gel filler clumps during transconjunctival lower blepharoplasty. Although usually possible to remove under eye filler using hyaluronidaze, sometimes filler clumps can remain.
Before & After Eye Plastic Surgery Photos
*See disclaimer below
29-year-old female, with under eye bags (fat prolapse) and dark circles (tear trough deformity hollowness), underwent transconjunctival lower blepharoplasty (scar-less, no stitch incision inside lower eyelid) with fat repositioning to get of the bags and fill in the hollow under area at the same time. The procedure was done under local anesthesia with oral sedation (xanax) in the office. You can find her story and surgical video on this page.
Before (left) and 3 months after (right) cosmetic quad-blepharoplasty, meaning bilateral upper blepharoplasty (with skin removed from upper eyelids) and bilateral lower blepharoplasty (transconjunctival incision with fat redraping).
Before (left) and 2 months after (right) cosmetic transconjunctival lower blepharoplasty with fat repositioning (using hidden stitch-less incision inside the lower eyelid, the fat pocket were redistributed to fill the hollow tear trough area) plus conservative skin removal using skin pinch method.
Before (left) and 2 months after (right) cosmetic eyelid surgery including upper blepharoplasty (“eyelid lift” to remove excess skin and tighten muscle) along with lower blepharoplasty (transconjunctival with fat repositioning and skin pinch).
73 year old female, with eyelid aging, underwent droopy upper eyelid ptosis surgery, upper blepharoplasty, lower blepharoplasty (transconjunctival with fat repositioning and skin pinch) and lateral pretrichial brow lift, under conscious sedation. Before and 3 months after eyelid surgery photos are shown.
Before (left) and after (right) 27-year-old male actor who complained of looking tired on camera due to under eye bags and dark circles (hollowness). He underwent cosmetic lower blepharoplasty (transconjunctival with fat bags repositioning).
47 year old female, c/o under eye bags and saggy upper lids, looking tired. She underwent transconjunctival lower blepharoplasty with fat bags repositioning and skin pinch plus upper blepharoplasty, under local anesthesia with oral sedation in the office. Before and 6 weeks after cosmetic Quad-blepharoplasty photos are shown.
Young mother, from N Dakota, with history of under eye fat bags worsened by under eye filler injection, underwent filler removal and transconjunctival lower blepharoplasty with repositioning of the fat bags to fill the hollow tear trough area. Before and 3 months after eyelid surgery photos are shown.
44 year old female, looking tired due to under eye fat bags and dark circles, underwent transconjunctival lower blepharoplasty with eye fat bags repositioning plus skin pinch. Before and 6 weeks postop photos are shown.
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Contact the Los Angeles Oculoplastic Specialists!
Dr. Taban is one of the leading oculoplastic surgeons in the Los Angeles region. Please use our online contact form to schedule an appointment for your next eyelid or eye treatment.
Next, read about Sunken Eye Treatment.
*Disclaimer: Results vary from patient to patient. Results are not guaranteed.