Are all surgeries for under eye bags done the same way?
I routinely see people concerned about having puffy under eye bags they state that the bags
under their eyes are always there regardless of what they do for their allergies or their
sinus issues as well as how much they sleep or how much salt they have in their diet
puffy eye bags that are always visible are likely due to something we call prolapsed orbital fat
this condition is also referred to as lower eyelid fat prolapse or
herniated fat lower eyelid fat prolapse is often a genetic feature seen in families
and something that can become more significant with facial aging a condition this common makes
lower eyelid surgery to address puffy under eye bags a highly sought after cosmetic procedure
the procedure to address under eye bags is called a lower eyelid blepharoplasty although this term
lower eyelid blepharoplasty is commonly used the procedure is not performed the same way by every
surgeon this can be very confusing for people who want to improve their under eye appearance some
of the most popular techniques are unfortunately prone to undesirable outcomes such as rounding
of the lower eyelids and even complications like lower eyelid retraction and ectropion
I’ll discuss different strategies and techniques for lower eyelid surgery I’ll cover some of the
key points of anatomy and surgical techniques so you can understand my recommendations
I’ll discuss the art of performing lower eyelid rejuvenation in a way that minimizes your risk for
complications and helps you look refreshed while preserving the natural character of your eyes
I’m Dr Amiya Prasad I’m a Diplomate of the American Board of Cosmetic Surgery
and a Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice in
New York City and Long Island for over 25 years I have been a strong advocate for natural results
and preserving individual character so people who know you can’t tell why you look better after any
type of procedure i perform i do procedures for lower eyelid rejuvenation every day and
my approach to lower eyelid blepharoplasty is based on strategies to minimize risk achieve
natural results and to facilitate recovery I perform a wide range of cosmetic eyelid surgeries
including specialized procedures that are not usually performed by general plastic surgeons
such as eyelid ptosis lacrimal gland prolapse and eyelid retraction surgery I’m also known for
performing surgical revision for complications of procedures performed by other surgeons
so what are the main concerns for people who come in for lower eyelid rejuvenation
it breaks down to three things one puffy under eye bags two under eye wrinkles and three
under eye dark circles the key to defining any solution is to first
accurately define the problem let’s start with the puffy under eye bags
as I mentioned earlier the puffy under eye bags are caused by prolapsed or herniated fat
in order to gain access to these fat compartments the conventional approach to surgery is to make
an incision below the eyelashes and to separate the skin and supporting muscles to get access to
these fat compartments this approach is called a transcutaneous blepharoplasty in my opinion this
approach of dissection results in a loss of the intrinsic strength of the eyelid structure which
is more strong intact than after the layers of the eyelid have been separated it’s like the
strength of a material like plywood which is made of thin layers of wood that are weak individually
but have strength when glued together loss of eyelid strength can cause the eyelid margin to sag
I prefer to perform lower eyelid fat modification from the inside of the eyelid using a technique
called transconjunctival blepharoplasty although this technique is considered to be
more technically advanced I make the effort in order to protect and preserve the integrity of
the tissue layers that would be separated from an external or transcutaneous blepharoplasty approach
the artifact modification is in performing sculpting and repositioning of the fat
such that you appear as if you never had bags under your eyes addressing under eye wrinkles
is where a lot of complications can occur and I’m consulted for this type of issue frequently
it’s common practice for surgeons to remove skin with the expectation that the wrinkles
will be smoother and that the skin will be tighter after this procedure unfortunately this particular
maneuver can contribute to rounding or retraction of the lower eyelids in some
situations the eyelid can even evert resulting in a condition called ectropion to make matters worse
not only does the cosmetic outcome not look good but the patient can also experience dry
eyes and other forms of eye irritation requiring ophthalmic management with eye drops and ointments
so how can this situation be avoided well there are two issues that should be addressed
the first is the assumption of skin excess the skin may appear to be excessive
if the supporting tendon called the lateral canthal tendon has become more lacks
this situation would be an indication for addressing the tendon as opposed to removing
skin if I see that the patient has lateral canthal tendon laxity I’ll perform a procedure called a
lateral tarsal strip to restore the stability of this very important support structure the second
issue is related to the appearance of wrinkled skin and it’s to differentiate skin quality from
skin quantity skin that appears to be redundant is more likely to benefit from procedures such as
fractional laser to induce collagen production and restore the skin surface with new layers of skin
that looks smoother skin removal can potentially cause a skin shortage that results in the eyelid
margin being pulled downward again resulting in eyelid ectropion or eyelid retraction in patients
with darker skin types who would not be candidates for laser I can stimulate collagen production with
a radiofrequency device like Pelleve I further enhance collagen stimulation with platelet-rich
plasma or PRP platelet-rich plasma is the concentration of wound healing and growth
factors found in the blood which are activated after an injury such as a simple cut another
benefit of PRP is the production of new blood vessels which can further improve skin quality
dark circles under the eyes are typically associated or caused by sun damage volume
loss or volume deficiency and a decrease in skin quality there are times when laser technology used
for wrinkles can also be used at the same time for discolorations under the eyes often seen with
sun damage for people with darker skin I often use PRP to address skin quality and skin discoloration
it appears that collagen stimulation and improved circulation to the skin
results in more refreshed and lighter appearance of under eye dark circles
to further develop the topic of all lower eyelid surgeries are not the same I look at bone volume
and projection below the eyes and the cheeks I’ve observed that prolapsed or herniated fat
often coexists with the deficiency in bone projection under the eyes and in the cheek bones
this deficiency in bone projection can be due to genetics or aging as well as
combination of the two it makes sense to reduce fat projection with surgery
and to enhance bone structure projection to create better balance and harmony in the past this bone
structure enhancement would have been achieved with surgical placement of facial implants
a newer technique called Structural Volumizing which was derived from
the principles of facial implant placement has made bone projection enhancement safe
predictable and without the downtime and risks of facial implant surgery so instead of implants I
use long lasting hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm Voluma which are
placed using a specific method this method allows for better projection and definition as opposed to
the pillowy and rounded appearance associated with the conventional approach to placement of fillers
as far as facilitating recovery I perform lower eyelid surgery using local anesthesia with
LITE IV sedation many of my colleagues prefer to perform eyelid surgery with general anesthesia
which is associated with side effects including nausea vomiting constipation
brain fog and prolonged recovery by contrast our patients are fully alert and comfortable after
surgery they generally return to work in about a week after surgery with minimal to no bruising
it should be abundantly clear at this point that lower eyelid surgery is not a standardized
procedure it’s important for you to have a clear understanding of your specific issues so you have
a clear strategy and minimize your risk of experiencing an undesirable outcome
I hope this information from my experience helped you
if you are interested in recommendations for your individual situation
you may contact us through our websites or call our offices to schedule a consultation thank you