What is eye bag surgery?

If your under-eyes always look puffy and tired, and if you have bulging lower-eyelid fat, you have eye bags. You may have inherited this trait from your parents.  The under-eye fat pouches consist of normal fat cells that surround the eye to act as a cushion.  If this fat is overly abundant or the fat pouches are exposed by hollowing of the upper cheeks, you will appear to have bags under your eyes.

For more on what causes eye bags, I made this infographic.

At this point in time (2015) there are 2 effective eye bag treatments.

1. Eye bag surgery that removes the fat pouches.  This is a long-lasting solution.

2. Filler injections that disguise the bags by inflating the surrounding areas.  This is a temporary fix and may not be as effective as surgery if the bags are severe (but it can be more effective that surgery if the primary issue is hollowing and not bulging fat).

There are some topical treatments (creams) that are being investigate that may reduce eye bags but these are not currently available in the U.S..

Eye bag surgery can be a “scarless” procedure

In some cases, as determined by your surgeon in a consultation, the fatty pouches can be removed from behind your eyelid.  This is called the trans-conjunctival approach because the incision is hidden on the inside of your eyelid (on the mucous membrane called the conjunctiva).  The majority of the eye bag removal surgery in NY that I perform is from behind the eyelid.  On occasion, I will recommend an in front of the eyelid incision if skin removal or eyelid muscle tightening is required.

Before and after “scarless” eye bag surgery

Dr. brett kotlus cosmetic oculoplastic lower blepharoplasty nyc

Eye bag surgery is about height and depth

For some people, a successful eye bag removal consists of fat removal only.  But if there is under-eye and cheek hollowing, additional measures are taken.  Fat from the lower eyelids can be shifted down to fill the under-eye hollows or fat injections are performed with cells taken from another part of the body.  In this way, the bulging fat pouches are lowered and the sunken areas are filled, creating a more level, smooth shape along the eyelid and cheek.

Where to have eye bag surgery

I may be biased, but I feel a cosmetic oculoplastic surgeon is the best choice for your eye bag removal surgery.  Other professionals trained in this procedure include fell0wship-trained facial plastic surgeons and  general plastic surgeons that have significant facial cosmetic experience.  Here in NY I perform this outpatient procedure in an accredited office-based surgical facility (most often) or in a hospital.

What to ask your surgeon before eye bag surgery

  • Ask how often they do the procedure and how they chose a certain approach for you.
  • Ask if they do other approaches or do they do the same technique for everyone
  • Ask to see photographic examples of the approach suggested for you and other approaches that were done for other issues (you want to make sure they are able to tailor the surgery to your needs and aren’t limited to a single technique)
  • Ask how often revisions are needed and what are the office policies regarding revisions
  • Ask if you can achieve similar results with a non-surgical procedure