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 interested in lower eyelid bag removal surgery. I have dreadful eyebags that won’t go away. I have tried all the home treatments and nothing works. I’m a young female at age 28 and the bags last all day. There are two bags under each eye. The past two years everyone has been asking if I’m exhausted or sick. It’s really affecting my self esteem. Can you help me? I am getting married next year and and I don’t want him to lift the veil and see my tired baggy eyes. Thank you for your time.
A: Lower eye bags are the result of fat that is sticking out from under the eyes and pushing out on the eyelids. Because there is a ligament of sorts that normally holds back this fat, when it protrudes it is known as herniated infraorbital fat. Usually it occurs as a result of aging but there are younger people who have it naturally. Known as congenital herniated infraorbital fat, I have seen and treated it as young as 14 years of age. Because you would be normally too young to have this as a result of aging, we can assume this is the result of a congenital weakness in the lower eyelid tissues that can not contain the fat.
This is a very correctable problem. There are two lower blepharoplasty techniques that can be used to eliminate the lower eyelid bags. The first is a transconjunctival (inside the eyelid incision) to just remove the protruding fat. (transconjunctival lower blepharoplasty) This is usually the best approach for younger patients or those that have no excess lower eyelid skin. The other approach is to reposition rather than remove the excess lower eyelid fat done through either internal or external incisions. The decision between the two depends the patient’s anatomy, age and their facial type.
Dr. Barry Eppley
Q: Dr. Eppley, I’m 22 and I’ve had bags under my eyes for a long time. I believe in my case it’s hereditary. I’m tired of hiding my eyes behind my glasses. I would like to know about procedures( a little scared) and around how much it would cost.
A: Given that you are only 22 years old, any bags under your eyes is congenital herniated infraorbital fat. You are too young to have any excessive skin of the lower eyelids. This could be improved by a transconjunctival (through the lower eyelid) blepharoplasty procedure. By going inside the lower eyelid, bulging fat can be removed from the lower eyelid area without an external incision underneath the lashline. This is a procedure that has a very rapid recovery with minimal bruising and swelling afterwards. There is usually a little drainage from the eye area for a few days from the incision inside the lower eyelid. (the incisions are not closed as sutures would rub against the eye ball and risk a corneal abrasion) Patients report little to no pain after the procedure. The typical cost of the procedure would be around $3500 which would include all associated costs.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 42 year-old female and have always had a touch of bags on my lower eyelids. Due to aging no doubt and some weight loss, these bags seem to have become bigger and at least they seem that way to me. I saw one doctor recently and she told me that I should have injectable fillers put in to puff out the indented areas around them. Then I saw another doctor and he told that the fat should be removed through an eyelid procedure. These two different opinions have me confused. What do you think?
A: Most undereye bags consist primarily of fat that has escaped from under the eyeball. Our eyeballs are encased in a bed of fat inside the eye socket bones. This allows the eye to be padded so it can move around inside its encasement without risk of being ruptured. This fat is held back by a ligament that runs from the lower eyelid down to the bone. With age that supporting ligament is naturally weak or weakens allowing the fat to come out from under the eye. Much like an abdominal hernia and protruding bowel, the lower eyelid develops bags of herniated fat. Some people have a natural weakness of this ligament and develop lower eyebags very early in life. (I suspect this is you) With aging they become much worse. Removal of this fat can be done from inside the eyelid without any external incisions. (transconjunctival lower blepharoplasty) This would make for a far superior result in your case. Adding more volume around the herniated fat is only going to make your lower eyelids even more puffy.
Dr. Barry Eppley