Eye Bag Surgery: Everything You Need to Know

Lower-lid blepharoplasty (eye bag surgery) is a cosmetic procedure used to remove under-eye bags. Eye bags are often age-related, and some people seek to have them surgically removed.

If you are considering this lower eyelid surgery, you can learn more about it to decide if it would be right for you.

What Is Eye Bag Surgery?

Eye bags are described as saggy pouches under the eyes. They develop in place of previously smooth, tighter looking skin under the eyes.

Eye bag surgery works by tightening muscles, removing excess skin, and potentially elevating suborbital (under the eye) fat to offer a more refreshed appearance.

There are two surgical techniques that are commonly used in lower lid blepharoplasty.

Transcutaneous

With a transcutaneous approach, an incision is made on the lower lid a little below the lash-line. During the procedure, excess muscle and skin are trimmed. A small amount of fat, which may be causing a bulge, is elevated.

Transconjunctival

With a transconjunctival approach, there is no scarring after surgery. The incision is made inside the lower eyelid. This is a good option in cases where the skin is relatively tight but the fat needs to be repositioned.

Contraindications

While the procedure is safe for most people, it is not suitable for everyone. If you are thinking about having this surgery, you must be evaluated to ensure that it would be safe and effective for you.

Conditions that may contraindicate this surgery include:

• Hypertension
• Diabetes
• Heart trouble
• Bleeding or clotting disorders
• Thyroid abnormalities
• Severe or unstable medical conditions

Other factors that won’t necessarily stop the surgery but may delay it include:

• Presence of dry eye irregularities
• Prior LASIK (laser epithelial keratomileusis) or photorefractive keratectomy (PRK)
• Smoking, which predisposes you to ocular surface disease and tear film problems
• Use of supplements such as niacin, echinacea, and kava, which can predispose you to ocular surface disease.

Potential Risks

While the surgery is generally well-tolerated, no cosmetic procedure is without risks—and eye bag surgery is no exception.

Some early postoperative complications include:

• Scratches on the clear part of the eye
• Eye hemorrhage

Some complications that can occur a bit later include:

• Abnormal positioning of the eyelid
• Double vision
• Muscle injury
• Increased exposure of the white part of the eye
• Scarring of the skin
• Abnormal tearing

Such occurrences tend to be rare.

Purpose of Eye Bag Surgery

This surgery is often considered when the eye bags affect the way a person feels about their appearance. The potential to present a rejuvenated appearance can be a real confidence booster for some.

How to Prepare

Before undergoing eye bag surgery it’s important to follow your healthcare provider’s directions. This may mean first giving up smoking—or at least refraining from doing so for four weeks before surgery. Smoking can interfere with the ocular surface and cause dry eyes.

Prior to the procedure, it’s important to talk to your healthcare provider about any medications and supplements you may be taking—prescription or otherwise. Some medications, even those that are over the counter, may put you at risk for excessive bleeding or predispose you to ocular surface disease.

Also, tell your healthcare provider what your goals are for the eye bag surgery and ask to see before and after pictures of similar cases. This will help you consider and discuss realistic expectations.

What to Expect the Day of Surgery

Surgery to remove eye bags is typically performed in an outpatient surgical center or office-based suite. At times, it may be done in a hospital setting. In rare cases, if you need to be admitted, you can expect to stay overnight.

If you are having a lower eyelid blepharoplasty, and no other cosmetic procedure along with it, it should take about 45 minutes to 1 hour. The surgery can take several hours if you are also having cosmetic correction to your upper eyelids.

Before the Surgery

Your surgeon will mark your lids with a surgical pen while you are in a seated position.

You will likely be given local anesthesia in your lid area, as well as topical drops on your eye so that you are numb to any sensations. Or, you may possibly be given intravenous (IV, in a vein) sedation, or general anesthesia, which will put you to sleep for the procedure.

You and your healthcare provider can discuss which pain control approach would be better for your situation.

During the Surgery

Your incision will be hidden along the lower lash-line. Your surgeon will then remove any excess skin, muscle or fat, and may reposition the tissue. After your procedure, the incision will be closed with fine sutures.

After the Surgery

You will likely be able to go home after just a few hours. You will be given a prescription for pain medication to keep you comfortable for the first few days after surgery. You likely won’t need to wear any bandages.



Recovery

Under-eye bag removal is generally well tolerated. You should begin to see signs of recovery soon after your procedure.

Healing

While your recovery should be pretty rapid, expect to take a few days off work and stay home. During the immediate recovery period, cold packs may help with any swelling or bruising. Keeping your head elevated can help minimize swelling.

After a few days, much of the swelling and discoloration should begin to disappear, but you may still see some signs for up to a month.

For the first few days after your surgery, you may experience some sensitivity to light, dry eye, and some blurred vision from lubricating ointments for your lids. Expect to have any stitches removed within the first three or four days after the procedure.

Long-Term Care

Make sure to avoid any strenuous activity for the first couple of weeks. Also, during this two-week period avoid using your contact lenses or wearing any makeup.