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Eye bag surgery

man with eye bag

Lower eyelid surgery is a common cosmetic surgery procedure performed on the lower eyelids to remove excess skin and reduce under-eye bags. Bagginess under the eyes is often a consequence of aging, as skin loses elasticity and forms a pouch under the eyes. The fat that is under the eyes then slips down. 

Under-eye bag surgery restores a more youthful, smooth look by removing that excess skin and fat. It is often performed with an upper eyelid lift so the entire eye area looks fresh and attractive.

READ MORE: How to get rid of bags under your eyes

Who is a good candidate for eye bag surgery?

Individuals who consider blepharoplasty (upper or lower eyelid surgery) have one or more of the following:

  • Eye bags that persist and don’t improve with a good night’s sleep.

  • Eye bags that cannot be easily camouflaged with makeup.

  • Obvious fat deposits under the lower eyelids.

  • Eye wrinkles and excess skin under the lower eyelids.

  • Dissatisfaction with the appearance of their eyes, feeling they look “old.”

What happens during eye bag removal surgery?

Just before your eye surgery, the surgeon will mark your eyelids. The procedure is usually performed under local anesthesia that numbs the eye, with some IV sedation added to help you relax while awake.

During lower eyelid surgery the doctor will make an incision below the eyelash line, either on the outside (called transcutaneous) or the inside (called transconjunctival). In either case, the incision will not be visible once it heals. 

The surgeon will then remove excess fat and skin responsible for the puffiness of eyelid bags. These orbital fat pads, as they are called, can sometimes be repositioned upward to give a more youthful appearance.

If needed, fat can also be taken from another area of the body, and grafted into place under the eye. This is called an autologous fat graft. Dermal fillers might also be used. 

Finally, the incision will be closed. Once the eye heals, the incision won’t be visible. Surgery takes from one to two hours. 

Are there other options besides lower eyelid surgery?

In some cases, for individuals with less obvious eye bags that do not have excess fat pouches, a surgeon may perform a quicker, pinch eyelid surgery. The skin is tightened and excess skin is removed, but the underlying muscle and fat is not touched. 

Other techniques can improve the appearance of mild eye bags. These include microneedling, laser resurfacing to stimulate skin cell renewal and collagen remodeling, and injectable fillers like those used around lips and in cheeks. Injectable fillers are often used on tear troughs, which are deep creases between the lower eyelid and upper cheek. Tear troughs often occur along with eye bags.

What should I do after surgery?

Your doctor will give you instructions for after-care. Instructions will include applying cold compresses to your eyes for the next 48 hours to reduce swelling. You may want to sleep with your head propped up to reduce swelling as well. Your eyes may appear bloodshot and red, and you may feel discomfort. 

You may also be given eye medications and asked to wear sunglasses to protect your eyes when you go outdoors. You will be asked to avoid strenuous activities for several days. If your doctor did not use absorbable stitches, the sutures will be removed after a week.

It takes about 10-14 days for most people to recover. Makeup can hide any fading bruises. It takes six weeks for complete tissue healing and recovery. Blepharoplasty should last a decade or more. 

What are the risks of eye bag surgery?

Eye bag removal surgery is considered a very safe procedure, but every surgery has risks. Bruising and soreness are to be expected. But beyond that, very rarely there can be infection, numbness or vision loss that is temporary or possibly permanent. 

One in 50,000 people suffers from temporary vision loss and one in 30,000 suffers permanent vision loss after this kind of surgery. This very rare complication is usually due to bleeding inside the eye. 

Another rare complication is when a surgeon removes too much fat and skin, leading to a startled look. The eyelid can also be malpositioned, leading to an uneven appearance under one eye. 

Another complication is lower eyelid retraction. This is when the lower eyelids are pulled down too far, and too much white shows between the lower lid and the iris. 

Dry eye syndrome is another possible risk. Cysts may form along the incision lines. And finally, infection is always a risk with any surgery.

If you experience any post-surgery problems, call your surgeon and your eye doctor.

How much does eye bag surgery cost?

Lower eyelid surgery is usually not covered by insurance, since it doesn’t impair vision in any way. The average cost for the actual surgery is a little over $3200, according to the American Society of Plastic Surgeons. But this does not include anesthesia, the cost of the facility where the surgery is carried out, prescriptions for medications or other related expenses. 

Remember to choose a board-certified plastic surgeon with years of experience. Make sure it’s a person who listens to your concerns and makes you feel comfortable. Questions you might ask include:

  • How many eye bag removal surgeries have you performed?

  • May I look at some before and after pictures of patients you’ve performed this surgery on?

  • What results should I expect?

  • Do you offer any other treatments for eye bags that are less expensive or less invasive?

Eye bag surgery can improve a person’s appearance, giving them a refreshed and youthful look. This rejuvenation can be a powerful confidence booster.

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Blepharoplasty (eyelid surgery). Emory Aesthetic Center. Accessed May 2021.

Microneedling: Advances and widening horizons. Indian Dermatology Online Journal. July 2016.

The role of lasers and intense pulsed light technology in dermatology.  Clinical, Cosmetic and Investigational Dermatology. February 2016.

Concealing of under eye orbital fat pads with hyaluronic acid filler: A case report. Journal of Cosmetic Dermatology. August 2019.

Recommendations for the treatment of tear trough deformity with cross-linked hyaluronic acid filler. Journal of Cosmetic Dermatology. January 2021.

Visual loss after blepharoplasty: Incidence, management, and preventive measures. Aesthetic Surgery Journal. January 2011.

Common eyelid malpositions after blepharoplasty. Ophthalmology Web. July 2014.

Lower eyelid retraction after blepharoplasty. American Journal of Ophthalmology. April 1980.

Reducing the incidence of dry eye symptoms after blepharoplasty. Aesthetic Surgery Journal. September 2004.

How much does eyelid surgery cost? American Society of Plastic Surgeons. Accessed May 2021.

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