Eyelid Bags make me look older. What can I do?

Doctor’s hands marking with dotted lines around a man’s eye prior to surgery

Eyelid Bags make me look older. What can I do?

“I looked in the mirror one morning and there they were: bags under my eyes! Maybe they were there for longer than I knew, but I couldn’t stop seeing them. I tried concealer, but they were still there. I tried cucumber slices: no help. So I mustered up my courage and made an appointment to talk to Dr. Ditesheim.”

This is the experience of a real patient who came to see me a while ago. I know many people have these same questions she had.

What are eyelid bags?

Very simply, fatty tissue that is normally cushioning the eye falls out of position and literally “hangs over the edge” of the bone rim under the eye. Because there are normal supporting structures around the eye, when the fat herniates (or is pushed forward), it creates a crescent or hammock shaped area where the fat falls and is held forming a bulge that we call an “eyelid bag.”

Will the eyelid bags get better?

Though the problem is caused by fat that has fallen forward, it is actually only a small amount of fatty tissue. If the fat swells as the results of a high salt diet or lack of sleep, the bags appear worse. This is because the volume in the hammock is greater. Anything that lessens fat swelling will make the eyes look better but the eyelid bags won’t go away.

How do I make the bags go away?

To make the bags go away, the fat has to either be taken out of the hammock or “smoothed out over the edge.” What makes beautiful natural-looking eyes is a slight roll under the lashes and a “low” or concavity that leads to a highlight on the cheek. When there are eyelid bags, there is a “high” where there should be a “low.” This creates an unnatural shadow that can’t be covered by make-up.

Does simply taking out the fat make the problem go away?

Not always. The problem is not that there is too much fat, but that it has fallen out of position. Sometimes removing a portion of the fat will be enough to restore the right curves. Other times building up the cheek can mask the eyelid bag. But, in some cases, the fat needs to be repositioned to create a natural look. Since everyone’s eyes are different, no one operation can be the answer for everyone.

Why is it a problem to take out a lot of fat under the eyes?

As we age, the normal fatty tissue that cushions the eye decreases. This is why people in their 90s have a more hollow appearance, the eyes literally have fallen back because there is less fat surrounding them and we see the bony edges instead of the softness of youth. If too much fat is removed, especially at a young age, the eyes will look prematurely aged and hollow.

Won’t filler fix the eyelid bags?

Remember, the problem is a high where we want a “low” or a convexity instead of a concavity. Depending on the relative position of the eye and the cheek, filler may soften the high by “filling in the low.” This filling in can be done with off the shelf fillers (Juviderm, Restylane, Radiesse, Belotero) or with lipofilling or fat grafting using your own tissue. Injecting around the eye can be dangerous if it is not performed by a qualified medical professional. Only an experienced board-certified plastic surgeon should be discussing this option with you.

If I have surgery, will the results be immediate and will they last?

Yes. Surgery always sounds much more drastic (and scarier) than creams or an injection but the right surgical solution will transform the eyes into natural youthful beautiful eyes again. The results will last for years and there won’t be the unnatural or premature hollowing.

Again, selecting the right option for you requires a consultation with an experienced board-certified plastic surgeon. During your consultation, ask what plan is best for you but also ask why. Ask to see results of the recommended procedure and ask about recovery. Lastly, when you understand what is being recommended, why it is the best option for you, and what to expect afterward, then you are ready to ask about the cost. To achieve a successful outcome, these are all questions you must have answered to your satisfaction in advance.

Dr. Jeffrey Ditesheim is more than a credentialed plastic surgeon. He is a sensitive and experienced professional whose focus is always to help his patient feel more beautiful and confident. Learn more about Dr. Ditesheim and read Dr. Jeffrey Ditesheim’s reviews.

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