Understanding lower blepharoplasty
Blepharoplasty, or surgery on the eyelid, is a commonly performed cosmetic procedure. While upper blepharoplasty can be cosmetic or a way of restoring eyelid function, lower blepharoplasty is usually cosmetic. This procedure can improve under-eye aesthetics by reducing eye bag puffiness and excess skin.
Eye bags do not usually cause health or vision problems, but they can be an aesthetic concern. They are most often caused by the loosening of the skin that comes with aging. Home remedies may help shrink eye bags, but a type of surgery called lower blepharoplasty can provide a longer-term fix.
As you get older, your muscles and tissues become weaker, allowing the fat underneath your eyes to sag forward and form “bags.” These eye bags can also happen when fluid builds up, causing swelling underneath the eyes.
Simple at-home treatments, like cold compresses, can help reduce eye bags or general puffiness. However, the most effective way to permanently remove under-eye bags is with medical or surgical treatment.
What is eye bag surgery?
Lower blepharoplasty is typically performed on the lower eyelid area to reduce or improve the appearance of bags under the eyes. The procedure involves repositioning or removing fat under the eyes, as well as excess skin around the lower eyelid. The surgeon can also tighten the tissues and muscles around the eyes.
It is important to note that lower blepharoplasty does not aim to remove all the fat beneath your eyes. Removing too much fat could result in a hollowed appearance in that area, so in many cases the fat is relocated to help smooth the transition to the upper cheek.
This procedure is most often performed by plastic surgeons, ophthalmologists and otolaryngologists. Ophthalmologists who are specialized in surgery around the eyes, known as oculoplastic surgeons, may also perform this procedure. It can also be performed by oral and maxillofacial surgeons.
Who gets eye bag surgery?
To determine if you’re a good candidate for surgery, your physician will review your medical history, including:
- Eye conditions
- Relevant past treatments and procedures
- Current medications
- Allergies
They will also conduct a physical examination to assess the positioning of your lower eyelids, the skin around your eyes and other factors.
Candidates should be in good health, without any eye or medical conditions that could prevent a successful procedure. It is recommended that candidates be 30 or older.
Eye bag surgery aims to improve the appearance of the under-eye area. It is a cosmetic surgery, so individuals with eye bags, under-eye puffiness or sunken eyes may benefit. Common cosmetic issues that can be managed with lower blepharoplasty, and their medical names, include:
- Rhytidosis – Excess wrinkles
- Dermatochalasis – Loose skin
- Steatoblepharon – Bulging fat pads under the eyes, giving the appearance of eye bags
- Pronounced nasojugal groove, or tear trough – When the skin area between the lower eyelid and the cheekbone appears hollowed or sunken
- Infraorbital/malar deflation – A hollowing or deflation of the infraorbital (beneath the eye) and malar (cheek) area
- Malar mounds – Soft tissue protrusions over the malar eminence, or the most pronounced area of the cheekbone
- Festoons – Lax folds of skin between the inside and outside corners of the eye
- Asymmetrical lower eyelids – Uneven lower eyelids
Eye bag surgery procedure
This surgery is typically an outpatient procedure. You can usually go home the day it’s performed. Local anesthesia is typically used, allowing the surgeon to check for symmetry during the procedure. However, in some cases, general anesthesia may be needed.
The surgeon will use a surgical pen to mark the borders of the eye bags or hollowed areas.
There are two techniques primarily used for lower blepharoplasty: The transconjunctival approach and the subciliary approach. Both procedures provide access to the fat pads beneath the eyes. The choice of technique depends on multiple factors, but the amount of excess under-eye skin is a major consideration.
Transconjunctival approach
The transconjunctival approach is typically the first choice when the goal is to remove excess fat from beneath the eyes. A surgeon may choose this approach for younger patients with fat pads but not much loose skin.
Typically with this technique, no external incisions are made to the skin below the eye. Rather, the lower eyelid is retracted (pulled back), and the incision is made in the conjunctiva to gain access to the fat pads underneath. (The conjunctiva is the clear membrane that covers the inside of your eyelids and the white of your eye.) Light pressure applied to the upper eyelid can push the fat forward for further access.
When the fat has been removed or repositioned, the surgeon may or may not use sutures to close the incision. The area usually heals well on its own.
Temporary sutures might be used in the corners of the conjunctiva during the surgery to help the surgeon see the area better. These will be removed afterward.
Subciliary approach
The subciliary approach involves an incision on the outside of the lower eyelid. It is often used for patients who need excess skin removed.
The incision is made in the skin below the eyelash line or within a skin crease. A flap of skin, or a flap containing both skin and muscle, may be lifted depending on what needs to be fixed. The incision provides access to the fat pads beneath the eyes, as well as the muscles and ligaments that can be tightened to better support the eyelid.
After the necessary adjustments are complete, the incision is closed with sutures.
Although the subciliary approach used to be the standard, transconjunctival surgery has become more popular in recent years because it’s less likely to leave a scar.
SEE ALSO: Types of eye surgery and the conditions they treat
Recovery and aftercare
Blepharoplasty is an outpatient procedure that may last up to several hours. Most patients are observed for at least 30 minutes following the procedure. You should arrange for a friend or family member to drive you home after the surgery. It might also be a good idea to have someone stay with you overnight.
It’s important to follow any specific aftercare instructions given by your surgeon. For example, they may provide a list of things to look for at the surgical site, medications to use for pain and inflammation, and when to return for a follow-up appointment. You should contact your doctor’s office right away if you have any problems or unexpected issues.
Your doctor will also tell you how to take care of your eyes after the procedure. There may be some bruising or swelling following under-eye bag surgery. Cold compresses for the first 24 to 48 hours following the procedure can help decrease the swelling. Warm compresses can be used after this. They may also prescribe an antibiotic ointment to help reduce swelling and prevent infection.
Intense physical activity should be avoided for up to a few weeks following the surgery. It may take a few months to heal completely, but most people are ready to go out again after 10 to 14 days.
Potential benefits
Lower blepharoplasty can reduce eye bags and puffiness under the eyes, resulting in a more youthful appearance. These aesthetic improvements can also result in increased body image and self-esteem.
This is a common cosmetic procedure that shows predictable and good results. Most people are satisfied with the outcome, and many reported they felt the procedure was worth the time and money.
Possible risks and complications
Lower eyelid blepharoplasty is regarded as a safe and effective procedure. People are generally satisfied with the results, and very few report significant discomfort.
However, there are risks to every surgery. Lower blepharoplasty tends to be more technical than upper blepharoplasty, and with an increased risk of complications. These may include:
- Paralysis or weakness of the muscle around the eye (the orbital orbicularis muscle)
- Ectropion, when the lower part of the eyelid turns outward
- Dry eyes
- Injury to the cornea
- Asymmetrical lids
- Lagophthalmos (being unable to fully close your eyelids)
- Retrobulbar hemorrhage, when blood accumulates in the area behind the eyeball (this is a rare but severe complication)
- Chemosis (swelling of the conjunctiva)
- Pyogenic granuloma (noncancerous tumor)
- Scarring, especially in the case of the subciliary approach
- Injury to the inferior oblique muscle, a muscle on the lower eye surface that helps with eye movements (this type of injury can sometimes cause double vision)
- Diplopia (double vision)
It’s also possible that the blepharoplasty may not adequately improve the look of the under-eye bags. Or the procedure could overcorrect. Removing too much fat could result in a hollowed appearance in the area.
Cost of eye bag surgery
The American Society of Plastic Surgeons estimates the cost of a lower blepharoplasty to be nearly $3,900. However, this number does not include anesthesia fees and other expenses.
If you need time to pay, ask your surgeon about a financing plan. Many plastic surgeons offer payment options for eye bag surgery.
Factors that influence cost
The surgeon’s experience, the surgical procedure used and geographic location can all affect lower blepharoplasty cost. Additional expenses for prescriptions, tests and facility fees can also add to the total.
Insurance considerations
Eye bag surgery is almost always cosmetic, so most insurance policies will not cover it.
However, there may be some cases where lower blepharoplasty might be considered medically necessary. For example, if eye bags are prominent enough to interfere with a person’s vision or their ability to wear glasses, surgery may be warranted.
It’s important to review your policy to see if any coverage is provided for the cost of lower blepharoplasty. Contact your plan administrator if you have any questions.
Choosing a surgeon
When looking for a surgeon, it’s important to consider their experience, training and board certifications. Because the eyes and surrounding area are so sensitive, it’s also recommended to find a surgeon who specializes in blepharoplasty or the eyelid area. A facial plastic surgeon or an oculoplastic surgeon is a very good choice for this type of surgery.
It is important to find a surgeon who can answer your questions and who you are comfortable with. A positive relationship with your physician can increase satisfaction with the treatment as a whole.
Good questions to ask during your consultation include:
- Am I a good candidate for lower blepharoplasty?
- What surgical technique do you think is best for me?
- How will you manage potential complications?
- What do I need to do to achieve the best results?
- What can I do if I’m not satisfied with the outcome?
You can also ask to view before and after photos to get an idea of your expectations for the procedure. Remember that eye bag surgery won’t alter the structure of your face or cause dramatic changes to your look. It’s important to be realistic and discuss your expectations with your doctor.
Alternatives to surgery
It may be possible to improve your under-eye appearance without undergoing surgery. There are several treatments you can try at home, as well as nonsurgical medical options.
Home remedies
At-home treatments can sometimes be used to temporarily reduce puffiness around the eyes. These include:
- Holding something cold over your eyes, like a cool compress, ice pack or bag of frozen vegetables
- Applying caffeine to your face in the form of an eye cream or a chilled tea bag
- Getting enough sleep
- Limiting what you drink before bed and sleeping with your head propped up to prevent fluid from building up overnight
- Controlling any allergies, which could be a contributing factor
Applying a hemorrhoid cream may also help get rid of under-eye bags because it has ingredients that can decrease swelling. However, it’s important to keep this medication out of your eyes to avoid irritation, so take extra care if you decide to try it.
Medical options
Your doctor may also suggest a nonsurgical medical option to help with your eye bags, such as:
- Dermal fillers, which are injected to help smooth out the appearance of eye bags.
- Laser treatments and chemical peels, which remove old layers of skin to reveal new skin underneath. They also stimulate new collagen.
- Plasma exeresis, which uses heat to coagulate the skin and promote skin tightening and stimulate collagen.
SEE RELATED: How to prevent swollen eyelids
Getting rid of under-eye bags
If you have eye bags, lower blepharoplasty may be able to help reduce puffiness and give your face a more youthful appearance. It’s often considered less painful than other cosmetic procedures and it has good satisfaction rates. And if the transconjunctival approach is used, it often does not leave a scar.
Nonsurgical options like laser treatments and dermal fillers may also help reduce the appearance of under-eye bags.
If you are considering surgery, it’s important to talk to your surgeon about the risks, complications and costs associated with lower blepharoplasty.
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