Q: Dr. Eppley, What I most dislike about my face at this time are the bags/creases under my eyes that make me look tired and old. There are also some fairly “deep” lines in my forehead. I am turning 35 next month, so I don’t think I want any type of surgery yet. I am interested to find out what types of options there are for me and what it might cost. Likely, I would do this in the spring time over school break. Thanks!
A: The earliest signs of facial aging always with exactly what you are seeing. Wrinkle lines on the forehead and/or around the eyes and the development of bags (herniated fat ) on the lower eyelids. Botox injections work well for forehead wrinkle lines. Lower eyelid bags are really best treated by removal. (transconjunctival blepharoplasty) But to those adverse to surgery, injectable fillers can be used to fill in the tear troughs created by the bags. Such injection treatments in my experience are a mixed ‘bag’ since they have a not rare problem of lumps and unevenness due to the thin skin of the eyelids. When they work well they are great but when irregularities develop the filler often has to be dissolved away by hyaluronidase injections.
Dr. Barry Eppley
Q: Dr. Eppley, I am quite old (66 years old) andI want to know if there is help for severe under eye bags and puffiness?
A: At 66 years old you are far from being too old to have surgery to improve your lower eyes. Such surgeries are safely done on patients up into their 90s. The cause of under eye bags and puffiness is largely herniated orbital fat. As we age the ligaments that hold the fat around the under eye weaken. The fat then gradually spills over the lower bony rim creating the bags that you see. Since such fat is very susceptible to water retention it can get very puffy particularly in the morning or after very salty foods.
Such lower eyelid bags are not treatable by any creams or other topical treatment methods. They can be dramatically improved by surgical reduction/repositioning of the herniated orbital fat to smooth out the lower eyelid. Usually a small amount of lower eyelid skin is removed as well. This is known as a transcutaneous lower blepharoplasty. While there will be some temporary bruising and swelling after surgery, the improvement can be dramatic once it is fully healed weeks later.
If you have any pictures off of your phone that you cane send me I can give a definite opinion as to the benefits of this type of eyelid surgery for you.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to know the cost for under eye surgery to remove bags. I don’t believe I need lid surgery.
A: Thank you for your inquiry. Your question as posed is contradictory. The removal of eyelid bags is a form of eyelid surgery that, if done in isolation, is accomplished through an incision inside the eyelid without outward skin removal or an imperceptible scar along the lashline. This is known as a transconjunctival lower blepharoplasty. While this type of lower eyelid procedure does not remove skin it is often combined with adjunctive lower eyelid skin tightening techniques such as chemical or laser peels. When excess skin as well as herniated fat exists, the removal of skin and fat is done through an external incision. This is known as a transcutaneous lower blepharoplasty.
I believe you were likely referring to the desire for transconjunctival lower blepharoplasty when you made the statement that ‘I don’t believe I need lid surgery’. That cost is usually in the range of $ 3,500 to $4,000 for both lower bags. If skin removal is needed this wil, raise the cost to about $ 4,000 to $ 4,500.
Dr. Barry Eppley