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Under Eye Bag Surgery– Lower Eyelid Surgery

Patients come from around the world to Prasad Cosmetic Surgery seeking under eye bag surgery to improve the appearance of tired looking under eye bags. Eye lift surgery or Blepharoplasty of the lower eyelid is performed to address under eye bags or puffy eyes.

Dr. Amiya Prasad, a leading oculofacial plastic surgeon, has performed eyelid surgery for more than 20 years and is considered one of the best in his field. People often seek lower blepharoplasty because their friends and family tell them they look tired because they have puffy eyes or sagging lower eyelids.

Before and After under Eye bag surgery on older male patient
Before and After under Eye bag surgery on male patient

What Causes Bags Under Eyes?

Puffy eyes – under eye bags are often misinterpreted as being caused by fatigue or allergies. The bags that are seen under the eyes that remain unrelated to sleep or allergies are due to lower eyelid fat prolapse. The fat padding that prolapses is referred to as orbital fat. This is based on the fact that the eye sits in a space called the orbit and this space has fat in compartments. To improve the appearance of the bags under the eyes, the excess fat may be removed, repositioned and sculpted.

Loose Skin – Many people are concerned that after the under eye bags are removed from under the eyes, there will be loose skin. Depending on the support of the lower eyelid, loose skin can be addressed at the same time. Often, the skin that accommodated the eye bags/fat pockets is tightened after surgery by the orbicularis oculi muscle. The orbicularis oculi muscle contracts like a belt and tightens loose skin.

Eyelid Support – People often referred to Dr. Prasad because of unrecognized problems with lower eyelid support. Properly restoring lower eyelid support requires several different specialized techniques. In addition, the support structures of the eyelid can be shaped in a way that can create a brighter appearance to the eyes.

Lower eyelid fat padding prolapse illustration

What causes eye bags?

Puffiness under the eyes is one of the most common concerns affecting men and women of all ages and ethnic backgrounds the retail shelves are full of creams claiming to get rid of under eye bags many of my patients come in with bags of these creams and other DIY remedies which all fail to deliver any of the benefits they claimed the social impact of having eye bags can be very significant younger people who are healthy and energetic are frequently perceived by others as being tired lacking in sleep and even under the influence of drugs I’ll discuss the different causes of puffy eye bags as well as treatments including non-surgical and surgical options to help people who i see with eye bags

I’m Dr Amiya Prasad I’m a board-certified cosmetic surgeon and a fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been practicing in New York City and long island for over 25 years when people come to see me they often report that they tried everything they could before taking the big step of coming in to see me they often will say how they were hoping to avoid needing surgery i say to them although surgery may be appropriate I’m more than happy to help people who are candidates using non-surgical procedures when appropriate i reassure them that being a surgeon provides a unique insight that enhances my skills in performing non-surgical procedures puffiness under the eyes can be seen temporarily due to the lack of sleep from allergies and even salt intake these types of puffiness are caused by fluid and is subject to lifestyle and environmental factors under eye bags which are always present are due to an anatomic issue called lower eyelid fat prolapse anatomically speaking fat pads exist in compartments around the eyes and can shift forward like a hernia the term for this  phenomenon is lower eyelid fat prolapse or herniated fat lower eyelid fat prolapse can be hereditary such as that many of my patients are younger people in their twenties and they’ve had their puffy eyes appearance since they were teenagers facial aging changes which are characterized by volume loss affecting the bones and soft tissues can also be associated with under eye fat packs certain lifestyle factors like smoking can also contribute to weakening of the delicate tissue around the eyes resulting in puffy eye bags thyroid eye disease can also cause you to have prominent under eye bags having puffy bags under the eyes is commonly perceived by others as you looking tired or lacking sleep one of the most common phrases i hear from my patients who have under eye bags is I’m tired of looking tired it’s important to recognize that under eye puffiness is often associated with a deficiency in volume below the eye this means that you can have too much volume pushing forward from lower eyelid fat prolapse resulting in the appearance of under eye bags and at the same time have hollowing due to the lack of volume in the bone structure below the under eye bags when i perform an examination of this area for rejuvenation i look at specific anatomic details one i look at how much the bags under the eyes are pushing forward two i look at the area of the tear trough and determine if the height of the under eye bags are more or less than the height of a bone located just in front of the fat pocket called the anterior lacrimal crest and third i look at the projection of the cheekbone and the area below the under eye backs strategy for this assessment is to determine if your appearance can be improved non-surgically  with the placement of hyaluronic acid filler or by performing surgical sculpting of the prolapsed fat pockets or even a combination approach using both surgery and cheek filler let’s look at a situation where the fat prolapse is minimal and the projection of the anterior lacrimal crest or the bone structure located towards the inner corner of the eye is at least the same height or higher than the height of the fat i can precisely place hyaluronic acid filler in a space between the fat and the bone to create a smoother transition and effectively camouflage the prominence of the fat pocket i perform this procedure in my exam room and my patient leaves the office with little evidence of having had a cosmetic procedure i often see people who went to injectors to have filler placed in order to camouflage the under eye bags and these bags were simply too large to address with filler alone that’s just time and money being wasted when under eye bags are too prominent to camouflage i recommend a surgical procedure called lower eyelid blepharoplasty i find that most people i see who are interested in improving their lower eyelids become familiar with this term through their online research some confusion occurs because surgeons offer different opinions on the type of surgery and the type of anesthesia that they recommend let’s start with the type of surgery the most commonly practiced approach to lower eyelid blepharoplasty is with a transcutaneous approach this means that the surgeon operates on the lower eyelid fat pockets through an incision made below the eyelashes in order to access the fat pockets the skin and supporting muscle is cut and separated before the fat pockets are sculpted it’s common for the surgeon performing this type of procedure to remove skin with the expectation that the wrinkled skin will look tighter afterwards as a specialist in primary cosmetic and revision eyelid surgery i can attest to the fact that many patients who have surgery performed in this way are at greater risk for problems such as lower eyelid retraction and ectropion partially due to skin shortage at a minimum many people who’ve had surgery performed in this fashion report that the shape of their eyes change in a way that is not characteristic of their original natural appearance they feel their eyes look too rounded these types of results are due to compromise of the delicate anatomic support structures responsible for retaining the natural shape of your eyes in addition the removal of skin under the eyes is based on an assumption that there is excess skin in my experience most people don’t have excess skin but rather have a deficiency in their skin quality in essence the skin appearance characterized by wrinkles and discolorations is due more to a loss of skin quality and not an excess of skin quantity in my practice i perform most of my lower eyelid blepharoplasties using a transconjunctival approach this means i approach the fat pockets to be sculpted from behind the eyelid thereby avoiding any external incision this approach also allows for the preservation of the delicate structures supporting the eyelid and maintaining your characteristically natural eye shape this procedure is considered more specialized and technically advanced the art of performing this surgery isn’t how i sculpt the fat and at the same time preserve fat so you can look as if you never had under eye packs my patients enjoy a more natural appearance and not looking tired as they did before in order to improve skin quality i use devices and regenerative technology for the purpose of refreshing the skin appearance and improving the skin quality through collagen production i’ll routinely use a combination of lasers such as fractional co2 laser fractional erbium laser or radio frequency instruments to accomplish this in order to further optimize collagen production and generate new blood supply to the skin i also use prp or platelet-rich plasma platelet-rich plasma is a concentration of the wound healing elements in your blood necessary when you have an injury like a simple cut i see a lot of patients who have significant fat prolapse resulting in very large under eye bags oftentimes the patient is so concerned about the bags under their eyes that they don’t recognize that the volume loss that was present below the bags as well as the volume loss also affecting their cheekbones during consultation i’ll often suggest having cheekbone or cheek enhancement with a long lasting hyaluronic acid filler at the same time of their surgery the technique i employ is derived from surgical techniques used for placement of silicone cheek implants i use the term structural volumizing for this as i’m able to create an improvement in volume and definition resulting in a more youthful appearance with hyaluronic acid fillers this is in contrast to conventional approaches to filler placement in the cheek area which is generally performed by placing the hyaluronic acid filler just below the skin this approach ends up creating frequently a stereotypical rounded or pillowy look which is far from youthful the results from addressing under eye bags as well as enhancing cheekbone appearance can be highly satisfying for the patient as far as anesthesia is  concerned I perform transconjunctival blepharoplasty with local anesthesia and light iv sedation so many of my patients are comfortable and are able to recover very quickly my patients appreciate being able to avoid the risks and recovery associated with general anesthesia you’re able to return to work in about a week with minimal swelling or evidence of surgery as a specialist in cosmetic eyelid surgery i’ve been able to help my patients with under eye bags improve their appearance non-surgically surgically and as well with the combination approach since the appearance of your eyes has such a significant impact on how you’re perceived by other people it’s important for you to understand these basic principles so you can make an informed decision when you’re ready to take the next step i hope you found this information helpful thank you for your question

Are You A Good Candidate for Lower Eyelid Surgery?

You may be a candidate for under eye bag surgery if:

  1. You always looked tired, even with plenty of sleep
  2. Your under eye bags are present throughout the day
  3. You have excess skin around the eyes
  4. You notice that applying makeup is becoming more difficult
  5. Your friends or family keep asking you if you’re tired or if you’re getting enough sleep

Dr. Prasad spends a lot of time with every consultation. During your consultation at Prasad Cosmetic Surgery, a special blepharoplasty examination will be conducted. The goal is to properly classify your unique features based on gender, age, ethnic background and skin condition. This will allow Dr Prasad to select the best approach for treating the under eye bags and improving the skin of the lower eyelids.

A few medical conditions make blepharoplasty more risky, including: thyroid problems such as hypothyroidism and Graves’ disease, dry eye or insufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. Being an oculofacial plastic surgeon with training in ophthalmology, Dr Prasad will advise you and discuss optimal treatments and surgical strategies to best maintain healthy eyes.

surgery to remove bags under eyes before and after

How to Get Rid of Bags Under Eyes

To address the under eye bags, loose skin and sagginess of the lower eyelid, lower eyelid surgery also known as blepharoplasty is performed.

There are different surgical techniques a surgeon can use to rejuvenate the lower eyelids, but the overall approach usually involves removing fat (or sculpting and redistributing the fat or septum) as well as removing excess skin and sagging muscle. Depending on the technique used, surgery time varies.

The two most common eyelid surgery approaches:

Transcutaneous Approach

– external incision in lower eyelid

Many surgeons commonly make an external incision just below the eyelashes when performing lower blepharoplasty known as the transcutaneous incision which means “through the skin”. This approach can be advantageous if there is sagging of the skin and the orbicularis oculi muscle (the muscle which supports the eyelid). A well placed incision can be virtually invisible when fully healed. Patients with darker skin may experience darker pigmentation (hyperpigmentation) along the incision line.

This approach often involves making incisions and flaps of the orbicularis oculi muscle. The delicate orbicularis oculi muscle is very important as it supports the lower eyelid like a hammock. If the integrity of the muscle is compromised, the shape of the eye can be altered.

This approach commonly used by general plastic surgeons who don’t specialize or have enough experience in eyelid surgery often results in “rounding”, “scleral show”, or pulling down of the lower eyelids called lower eyelid retraction. This type of surgery should be performed with an understanding of other eyelid procedures to preserve the natural shape of the eye.

Transcutaneous-Blepharoplasty-still

Transconjunctival Approach

– Incision in the Inside of the eyelid

An approach which requires knowledge of the delicate structures close to the eye, so it mostly performed by eyelid surgery specialists like Dr. Prasad. He uses the internal incision known as the transconjunctival blepharoplasty (from inside the eyelid) when he performs lower eyelid blepharoplasty. This approach has several benefits:

No external incision so signs of surgery are unnoticeable. Even a close up eye exam will not reveal signs of surgery.
The shape of the eye is typically better preserved as the orbicularis oculi muscle integrity is preserved.
Minimal trauma to the fragile support network of the eyelid structure.

tranconjunctival blepharoplasty incision illustration

Transcutaneous Approach

– external incision in lower eyelid Transcutaneous Blepharoplasty incision illustrationMany surgeons commonly make an external incision just below the eyelashes when performing lower blepharoplasty known as the transcutaneous incision which means “through the skin”. This approach can be advantageous if there is sagging of the skin and the orbicularis oculi muscle (the muscle which supports the eyelid). A well placed incision can be virtually invisible when fully healed. Patients with darker skin may experience darker pigmentation (hyperpigmentation) along the incision line. This approach often involves making incisions and flaps of the orbicularis oculi muscle. The delicate orbicularis oculi muscle is very important as it supports the lower eyelid like a hammock. If the integrity of the muscle is compromised, the shape of the eye can be altered. This approach commonly used by general plastic surgeons who don’t specialize or have enough experience in eyelid surgery often results in “rounding”, “scleral show”, or pulling down of the lower eyelids called lower eyelid retraction. This type of surgery should be performed with an understanding of other eyelid procedures to preserve the natural shape of the eye.

Transconjunctival Approach

– Incision in the Inside of the eyelid

tranconjunctival blepharoplasty incision illustrationAn approach which requires knowledge of the delicate structures close to the eye, so it mostly performed by eyelid surgery specialists like Dr Prasad. He uses the internal incision known as the transconjunctival blepharoplasty (from inside the eyelid) when he performs lower eyelid blepharoplasty. This approach has several benefits:

No external incision so signs of surgery are unnoticeable. Even a close up eye exam will not reveal signs of surgery.
The shape of the eye is typically better preserved as the orbicularis oculi muscle integrity is preserved.
Minimal trauma to the fragile support network of the eyelid structure.

Many people who consider lower eyelid surgery also choose to have upper eyelid surgery.

What Type of Anesthesia Used During Lower Eyelid Blepharoplasty?

Oculoplastic surgeon Dr. Amiya Prasad developed his own approach to IV sedation combined with local anesthesia called LITE™ anesthesia. General anesthesia where a patient is paralyzed, and a tube is placed in the throat connected to a respirator is avoided. Local anesthesia allows patients to recover faster from all types of cosmetic surgery (with the exception of complex rhinoplasties/nose jobs) and go back to normal life quickly. Dr. Prasad’s patients have benefited with a comfortable and quick recovery with his unique anesthesia method.

What is Recovery Like After Eye Bag Removal Surgery?

Following eye bag surgery, minimal swelling and some bruising are typical, which diminishes anywhere from within a week to ten days. Most patients return to work in one week. You will receive specific instructions for your recovery and typically have a follow up with Dr. Prasad in about one week.

plastic surgery bags under eyes before after
plastic surgery bags under eyes before after

Can Under Eye Bags Be Removed Without Surgery?

For some people with slight puffy bags and hollowing of the cheek area, hyaluronic acids fillers like Restylane may be used to blend and camouflage the bags temporarily. During your consultation with Dr Prasad, he will advise you on the suitability of using fillers to treat your under eye bags. If there is only a slight amount of fat in the eye bags, under eye fillers can be used as a short-term alternative to surgery.

What are the Risks Involved with Lower Eyelid Surgery?

Risks for lower eyelid surgery will be discussed with you prior to your surgery. As a highly experienced specialist, Dr. Prasad will help you understand how you can minimize risks for complications and how he will approach your procedure to minimize risks related directly to the surgery.

Is it Better to Use Laser for Under Eye Bag Removal ?

A laser is an instrument. The benefits of lasers for lower eyelid surgery depend on the the types of lasers used and the skills of the surgeon. Dr. Prasad has been using lasers to optimize the results of lower eyelid surgery for 20 years. He will discuss with you if lasers will provide advantages for your surgery.

Frequently Asked Questions (FAQs)

How much does lower eyelid surgery cost?

The cost of eyelid surgery is based on surgeon’s fee, anesthesia, facility fees, and extensiveness of the surgery. Dr. Prasad performs his surgeries at his state-of-the-art surgical facilities to provide the highest level of safety for his patients. Financing options are available.

Can eye bag surgery go wrong?

Eye bag surgery is a popular type of cosmetic procedure; but many people still end up with undesirable outcomes due to complications of surgery. Many of these undesirable results include:
• Drooping lower eyelids
• Skin shortage that hinders the eye from closing properly
• Lower eyelid scleral show
• Lower eyelid retraction
• Ectropion
To avoid these problems, it is important to seek out the services of a surgeon who specializes in eye bag surgery, so you can be assured that he will have a deeper and extensive level of training and specialization in the field. It also helps to pursue a cosmetic surgeon who will be committed to understanding your own aesthetic goals, as well as the kind of outcome you hope to see.

Does lower blepharoplasty get rid of wrinkles?

Blepharoplasty mostly addresses the fat inside the lower eyelid, and sometime excess skin. The surgery will not make a significant improvement when dealing with the textural quality of the skin. For dynamic wrinkles around the eyes appearing when smiling/squinting, treatments such as Botox® are used to minimize the activity of the muscles that cause wrinkles. For the wrinkles that appear when the face is at rest, also known as static wrinkles, non-surgical treatments like fractional CO2 laser, PRP or are used to tighten the skin, increase collagen, and generally improve quality of the skin to help in the appearance of lines.

What age should you get a blepharoplasty?

While eye bags can be caused and increase in volume due to aging, it is mostly a genetic issue that can affect younger people. Dr. Prasad commonly performs eye bag removal surgery in patients in their 20s, who have said they’ve had the puffiness since their teen years or younger. He has performed blepharoplasty for eye bags in three generations of the same family. Dr. Prasad’s youngest patient for eye bag surgery was 14-years-old, as the eye bags were so severe he was teased at school and accused of being on drugs.

What cream can get rid of under eye bags or puffy eyes?

Although many creams claim to treat puffy eyes, no cream can address prolapsed lower eyelid fat since creams are topical on the skin, but the cause of eye bags are underneath the skin. Bags under the eyes cannot be treated with topical eye creams, no matter how expensive. It’s important to understand how the underlying structure of the lower eyelid changes over time. Creams may make the skin appear smoother, but the underlying source of puffiness needs to be treated medically.

For more answers to frequently asked questions click lower eyelid surgery FAQ videos

 

Under Eye Bag Surgery in NYC and Long Island, New York

To schedule a consultation with the Board-certified Oculoplastic surgeon Dr. Prasad, contact us at our Manhattan office at (212) 265-8877 or Garden City Long Island office at (516) 742-4636. Patient financing options are available for qualified candidates.

Patient Reviews on Eye Bag Removal

under eye bag surgery reviews: Thrilled with the results of my under eye procedure. Dr. Prasad is a wonderful doctor, I absolutely recommend anyone considering eyelid plastic surgery to consult with Dr. Prasad. Reviewer: R.K.
I can’t say enough good things. Dr. Prasad should definitely be considered if you want an experienced, professional, doctor with great bedside manners. His services were worth every penny. Reviewer: Kayshaw
Getting my lower eye surgery performed by Dr. Prasad was one of the best decision I have ever taken. I will highly recommend Dr. Prasad to my family and friends. Reviewer: NANAAMA
scarless eye bag removal review: They acted very professional and friendly. His approach does allow quick recovery, and no under eye bags no more. Thanks. Reviewer: AuraCs
Excellent 100% satisfactorily. I felt very satisfied with the consultation, procedure, and aftercare. I felt like Dr. Prasad was honest about the results and didn’t promise something unrealistic. Reviewer: Dam.andez
Fresh eyes, happy face. I am so happy I made the choice of removing my bags by Dr. Prasad. There was no scar, no pain, no worries. He is an artist at his craft. Reviewer: ArazPL
Rejuvenated look after eyebag surgery, results look very natural. I would recommend Dr. Prasad for his level of expertise and professionalism. Reviewer: Isabe
After consulting many surgeons, I went with Dr. Prasad. I am now a month after the surgery. I am very happy with the results. I do not look sleepy or tired like I use to. Reviewer: Jessidea
Dr. Prasad is a gentleman, genius, and a pioneer! Eye bags removal – new york. My results have been amazing and my experience with the whole staff including Linda and Ania. Reviewer: Sparker35

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