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Is Lower Blepharoplasty Permanent?

Are the results of eye bag surgery permanent? Under eye bags which are present all the time is caused by fat pockets located under the eyes pushing forward like a hernia this puffy appearance is often seen running in families as a genetic trait bags under the eyes are also associated with aging sinus problems and allergies During the course of a consultation for under eye bags patients will often ask me is the surgery for eye bags that they’re planning to have going to be permanent I’ll discuss how i address concerns about the longevity of results you can expect after having surgery for under eye bags I’m Dr Amiya Prasad I’m a board-certified cosmetic surgeon and fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice in New York City and long island for over 25 years i specialize in cosmetic eyelid surgery as well as revision eyelid surgery for complications referred by other doctors one of the most popular procedures I perform for under eye bags is called transconjunctival blepharoplasty in conventional plastic surgery under eye bags are approached by the surgeon making an incision through the skin this approach is called a transcutaneous blepharoplasty in this conventional approach an incision is made just below the eyelashes so the skin and underlying muscle can be elevated in order to gain access to the fat pockets in my practice my preference is to access the under eye fat pockets through a transconjunctival approach this means that i’m able to treat the fat pockets responsible for your under eye bags from the inside of the eyelids thereby leaving the outside skin and supporting muscles intact and undisturbed this technique is considered technically advanced and can be challenging for a surgeon in comparison to a transcutaneous approach i prefer the transconjunctival approach because it allows me to preserve the shape and character of your eyes much more predictably than with a transcutaneous approach i see a lot of patients for complications from transcutaneous blepharoplasty these complications include problems such as lower eyelid retraction and ectropion a common complaint i hear from patients who have undergone transcutaneous blepharoplasty from the outside is that they feel that they’ve lost the shape that was characteristic of their eyes they complained that their eyes ended up looking rounded and that they don’t look like themselves in addition i often see patients complaining of having dry eyes after this approach dry eyes can be caused by excess eye exposure or from a too low position of the lower eyelid after surgery this limits the tear film distribution many of my colleagues justify performing transcutaneous blepharoplasty because they want to do something about under eye wrinkles by removing the skin in order to make the skin appear to be tighter i respectfully disagree with this assertion on the basis that under eye wrinkles are caused by a loss in skin quality related typically to aging as well as other contributing factors such as excess sun exposure smoking and environmental stressors to the skin although it may look like there is extra skin under the eyes for most people there’s actually no excess skin essentially we’re not dealing with a skin quantity problem but rather a skin quality problem this means that when a transcutaneous blepharoplasty is performed you can end up with a skin shortage resulting in problems such as as i mentioned before eyelid retraction and ectropion since the main issue with the under eye skin is skin quality we can improve the skin quality with issues such as wrinkles and skin discolorations through procedures such as fractional co2 laser resurfacing the objective in using fractional co2 laser is to refresh the epidermis and to strengthen the dermis the dermis is the foundation of your skin and precise heat application to the dermis stimulates new collagen production thereby improving the appearance of wrinkles i further enhance skin healing and collagen production with prp or platelet-rich plasma prp or platelet-rich plasma is a concentration of the part of your blood responsible for wound healing two key aspects of wound healing is the creation of new blood vessels and the production of new collagen both of which are needed for healthy looking skin as mentioned earlier i sculpt the prolapsed fat responsible for under eye bags by performing transconjunctival blepharoplasty generally speaking after i perform transconjunctival blepharoplasty your eyes retain their natural shape since the skin muscle and other support structures are not violated and are left intact some of the art in performing transconjunctival blepharoplasty is dynamically judging the effect of fat sculpting on your appearance as i’m performing the surgery my target is to create the appearance as if you never had under eye bags oftentimes people with under eye bags also have deficiencies in their cheekbone structure additionally in your 40s and older there is a diminishing in bone volume as well as loss of soft tissue skin thickness and fat volume this is why i often combine surgery with the placement of long lasting cheekbone filler at the bone level using a technique called structural volumizing the fat pockets responsible for under eye bags exist in specific anatomic compartments when fat is sculpted from these compartments it’s unlikely that new fat will occupy these same compartments in the future however since there is still fat located further behind the fat that was sculpted as aging and bone volume loss progresses there is the possibility that additional fat may shift forward later in life this means that the longevity of results is going to be different for someone who’s having their procedure in their 20s in comparison to someone who’s having it in their 60s speaking from experience it’s not unusual for patients to enjoy the results of their lower eyelid surgery for 10 to 20 years and even longer as stated earlier other aging changes can be addressed with volume enhancement laser and other surgical options in my practice i perform transconjunctival lower eyelid blepharoplasty using local anesthesia with light iv or intravenous sedation my patients appreciate the advantages of this approach in comparison to the risks and recovery associated with general anesthesia usually i have my patients returned to work in about a week with minimal evidence of bruising or swelling if you’re considering surgery for under eye bags you can be optimistic about the long-term benefits of this procedure since the human body is not permanent future aging changes around the eyes and cheeks can be addressed as needed i hope you found this information helpful thank you for your question

People frequently inquire about the permanence of the results of various cosmetic procedures. Unfortunately, we have yet to discover the fountain of youth, which would imply a permanent result. However, for under eye bags that are present all the time, which are most often a genetic condition, but can also be caused by aging, we can consistently achieve long-term results that can last for decades, and in some cases, results can be permanent.

woman with under eye bags

Causes of Eye Bags

The first issue to address is the underlying cause of persistent under eye bags. Orbital fat usually surrounds the eyeball for cushioning. Orbital fat sometimes prolapses or pushes forward, similar to a hernia, causing these bulges under the eyes.

Lower eyelid fat pads prolapse can be a hereditary condition that’s why eye bags can appear in younger people. Board certified Oculoplastic Surgeon Dr. Amiya Prasad has operated on patients with eye bags from three generations of the same family. Eye bags can also be a sign of facial aging, where prolapsed fat develops or worsens with age.

eye bag surgery before and after
eye bag surgery before and after

Eye bags caused by prolapsed fat are treated definitively with lower eyelid surgery, also called lower eyelid blepharoplasty. The procedure involves sculpting the prolapsed fat surgically, then removing the sculpted fat. The art of this surgical procedure is in leaving a little fat behind to ensure a beautiful contour, and preventing a hollow appearance under the eyes.

What is Transconjunctival Blepharoplasty?

As mentioned earlier, the fat that causes eye bags is sculpted using the transconjunctival blepharoplasty method, which is done from behind the lower eyelid so there is no incision in the lower eyelid. Transconjunctival blepharoplasty appears more natural because there is no visible external incision, and it is less prone to complications. The external incision is used in the transcutaneous blepharoplasty method, which is more commonly used, and can compromise lower eyelid support structures.

Transconjunctival blepharoplasty is a more specialized procedure performed by fewer surgeons. General plastic surgeons are not tested on transconjunctival blepharoplasty for Board certification instead they are trained and tested on transcutaneous blepharoplasty. Transcutaneous blepharoplasty involves an incision along the eyelashes to access the fat pockets for sculpting and removal.

Before and After lower eyelid surgery using Transconjunctival Blepharoplasty technique - female patient
Before and After lower eyelid surgery using Transconjunctival Blepharoplasty technique - female patient

Treating under eye wrinkles is another important factor in avoiding complications from eye bag surgery. Under eye wrinkles are the result of diminished skin quality due to aging, as well as other factors like excessive sun exposure, smoking, and pollution, which can hasten the effects of aging.

Possible Complications from Transcutaneous Blepharoplasty

Many surgeons remove a small amount of lower eyelid skin when performing transcutaneous blepharoplasty, believing that this will improve the appearance of wrinkles. However, this causes a skin shortage, causing the eyes to appear rounded or pulled down, a condition called lower eyelid retraction.

lower eyelid retraction example - older female

The remaining eyelid skin can also evert outward, a condition known as ectropion, or invert inward, a condition called entropion. Skin removal can also cause improper eye closure, which can disrupt sleep and cause eye irritation. These complications are expensive to surgically correct, and Dr. Prasad frequently performs lower eyelid restoration for patients who have had their eye bag surgery performed by other doctors.

before and after eyelid surgery revision or blepharoplasty revision - older female patient
before and after blepharoplasty revision - older female patient

These complications are avoided by using the transconjunctival blepharoplasty approach. Which doesn’t use an external incision in the lower eyelid, and by not removing any skin to treat wrinkles as they’re a problem of skin quality, not excess skin quantity.

How to Reduce Wrinkles Under Eyes

To address under eye wrinkles Dr. Prasad will use platelet-rich plasma or PRP, to improve the quality and texture of the lower eyelid skin, as well as laser or radiofrequency treatment to tighten or resurface the skin to reduce the appearance of wrinkles. He only removes lower eyelid skin when excess skin folds over in the lower eyelids, in which case a skin pinch blepharoplasty is performed.

Skin pinch before and after surgery performed by Dr. Amiya Prasad
skin pinch surgery before and after performed by Dr Amiya Prasad

To understand the longevity of eye bag removal surgery, one must first examine the behavior of orbital fat. The volume of orbital fat does not increase with weight gain or decrease with weight loss, even extreme weight loss such as starvation, or extreme weight gain like obesity. Orbital is always present because it serves the function of cushioning and positioning the eyeball.

Once prolapsed orbital fat is sculpted and removed, that same fat does not come back. It is not uncommon for patients to have the results of their under eye bag surgery last 20 years with no recurrence of their eye bags. Dr. Prasad recently received a letter from one of his first patients, who stated that her eye bags never returned even 30 years after Dr. Prasad performed her surgery.

before and after male upper and lower eyelid blepharoplasty with fractional CO2 laser and platelet rich plasma PRP
before and after male upper and lower eyelid blepharoplasty with fractional CO2 laser and platelet rich plasma PRP under eyes

Since the results of eye bag removal surgery can last for so long, it is often a permanent procedure for many patients. However, even if the removed orbital fat does not return, there is no guarantee that new orbital fat will form and prolapse forward, causing eye bags again. MRI studies have shown that new orbital fat can form for protection and cushioning of the eyeball, and there is a chance that new orbital fat can prolapse forward, causing eye bags again.

Lower Blepharoplasty Results

To answer the question if eye bag surgery or lower blepharoplasty is permanent, there is no guarantee that results can be permanent, but results are usually long-term and can last decades. Since the effects of eye bag removal surgery can last for so long, for many people the results are permanent.

Of all the cosmetic surgeries from upper eyelid surgery, facelifts, brow lifts, and neck lifts, the results of lower blepharoplasty for eye bags will likely last the longest. Unlike the upper eyelids, where eyelid skin stretching due to aging continues after surgery, making the upper eyelids appear hooded over time, fat in the lower eyelids does not accumulate gradually.

lower eyelid blepharoplasty before and after
lower eyelid blepharoplasty before and after

View more lower blepharoplasty before and after photos

The same comparison can be made with facelifts, where skin, muscle, and soft tissue experience progressive laxity because of continued aging after surgery, but the same does not apply to prolapsed fat. The prolapsed orbital fat under the eyes is not a progressive condition, and the same fat that was sculpted and removed doesn’t return. New orbital fat can prolapse years after the initial eye bag surgery, it will likely be more sudden, rather than progressive like other facial aging changes.

Lower lid blepharoplasty for eye bags can be expected to last longer than most other cosmetic procedures, with results often lasting decades, and in some patients, even a lifetime. However, it is important to remember that our bodies are not permanent, as aging changes occur after any cosmetic medical procedure, and we have not discovered the Fountain of Youth that can stop the effects of aging.

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