Q: Dr. Eppley, I am 72 years old and in excellent health… exercise, good diet, etc. When I was around age 45 I had a blepharoplasty operation as I had developed large bags under my eyes. The surgery was to remove fatty tissue from my eyelids. It did me a world of good, as I was quite self-conscious of my appearance. Those bags have gradually come back and I am, again, very self-conscious of them. I look relatively young except for this excess fatty tissue. I can hardly imagine how I would look now had I not had the first operation! My question is how could this fat come back since I haven’t really gained any significant weight. Can they be removed again and do you think that it would be covered by Medicare? Thank you for your help.
A: Bags that develop from the lower eyelids is a common problem that occurs largely in aging eyes and occasionally in younger people due to genetics. The bags are due to fat which is sticking out from underneath the eyeball. One can think of it as a hernia. Our eyeballs are surrounded for their protection by fat. This fat is held in place underneath the eyeball by a special tissue that runs from below the lashline (tarsus) of the lower eyelid down to the rim of the lower eye socket. As we age this tissue becomes weak and the fat is no longer held back and begins to stick out. (bags) For some people, they have a congenital weakness of this tissue and they may have bags as early as their teen years. Once this protruding fat is removed, it is still possible later in life for it to ‘return’. This is really just more fat that is coming out from around the eyeball as the supporting tissues become weaker. Like the first surgery, further fat can be removed by additional lower blepharoplasty surgery.
Lower eyelid surgery is never covered by insurance because it does not interfere with one’s vision. Only the upper eyelid can create that medical problem.
Dr. Barry Eppley