A common concern for people considering lower eyelid surgery for under eye bags is if the
lower eyelids would sag afterwards.
This is in part due to the conspicuous “bug eyed” or “sad eyed” appearance of some
celebrities and politicians who my patients refer to.
I’ll discuss my approach to lower eyelid surgery to help people avoid lower eyelid
sagging.
I’m Dr Amiya Prasad.
I’m a Diplomate of the American Board of Cosmetic Surgery and Fellowship-trained Oculofacial
Plastic and Reconstructive surgeon.
I’ve been in practice in New York City and Long Island for over 25 years.
I routinely perform lower eyelid surgery for under eye bags in my practice using a technique
called transconjunctival blepharoplasty.
I avoid making an external incision in the lower eyelid skin and I’m able to preserve
the shape and character of your eyes.
The results look natural, as if the eye bags were never there.
I also routinely perform cosmetic upper eyelid surgeries to treat hooded eyes, and specialized
procedures such as Asian double eyelid surgery and eyelid ptosis correction.
As a cosmetic eyelid surgery specialist, I also perform revision eyelid surgeries to
address complications of surgery performed by other surgeons.
People with under eye bags often express a concern that if the volume of fat that causes
eye bags were to be removed, the eyelid skin would sag because the volume is no longer
there to support the skin.
They think in terms of the sagging skin that remains after someone loses a lot weight.
The lower eyelid anatomy is different from the abdomen.
The muscle supporting the lower eyelid, called the orbicularis oculi muscle is in front of
the fat as opposed to the abdomen where your abdominal muscles are behind the fat under
your skin.
This orbicularis oculi muscle acts like a belt, which tightens the lower eyelid after
the fat is sculpted during surgery.
There are other structures such as the lateral canthal tendon which may need to be addressed
if there is laxity to prevent lower eyelid sagging.
Rounded lower eyelids are referred to medically as lower eyelid retraction.
Lower eyelid retraction is oftentimes seen when lower eyelid surgery is performed from
an external incision called transcutaneous blepharoplasty.
Unlike my preferred approach transconjunctival blepharoplasty that has no incision on the
eyelid skin, the transcutaneous blepharoplasty technique involves an incision on the lower
eyelid, just below the eyelashes.
This approach can compromise the support of the eyelid skin, such as the orbicularis oculi
muscle, and the lateral canthal tendon resulting in downward displacement of the lower eyelid.
Well intended surgeons will often remove skin in an effort to address skin wrinkling.
Unfortunately, this can cause a skin shortage, which contributes to lower eyelid retraction.
In my experience, in the lower eyelids, skin wrinkling is more due to loss of collagen
and an reduction in skin quality.
Instead of removing skin to treat wrinkles, I prefer to treat t to improve the appearance
of wrinkles and crepey skin non surgically with lasers, radio frequency technology and
PRP.
I routinely use lasers such as a fractional CO2 laser, fractional erbium laser and long
pulsed Erbium laser which we refer to as “smooth eye” laser.
PRP or platelet-rich plasma is a concentration of the wound healing and growth factors found
in the blood to help heal an injury such as when have a cut.
All these tools help stimulate collagen production, increase blood supply and improve the outer
skin texture.
I perform the transconjunctival method of lower blepharoplasty using local anesthesia,
with LITE IV sedation, avoiding the risks and complications associated with general
anesthesia.
My patients usually return to work about week after surgery.
Closing: The take home message is that fat reduction
in the lower eyelids does not directly cause the skin to sag.
The approach to surgery and the application of lasers and PRP can make all the difference
for situation so you can look your best.
I hope you found this information from my experience helpful.
If you’re interested in recommendations for your individual situation, you may contact
us through our websites or call our offices to schedule a consultation.
Thank you.