Skin or fat? It decides the technique
“Under-eye bags” can mean several different things. Most often it is orbital fat bulging forward because the structures that hold it back weaken with age. Lax, wrinkled skin may add to it, and sometimes swelling or looseness of the lid itself.
Lower eyelid surgery mainly corrects fat bulging and excess skin. It does not remove pigmentation (dark circles), fluid-related puffiness or so-called festoons on the cheekbone. See our guide to under-eye bags.
Surgical techniques
Transconjunctival approach
The incision is made on the inside of the lid, so there is no skin scar. It suits patients whose main problem is bulging fat and whose skin quality is good – often younger patients. Fat can be partly removed or moved into the hollow (tear trough) to smooth the transition between lid and cheek.
Transcutaneous approach
The incision runs just below the lash line and extends slightly towards the outer corner. It allows excess skin removal, fat correction and – if needed – tightening of the lid support (canthopexy) to reduce the risk of the lid pulling down. The scar is usually barely visible once healed.
The doctor chooses the technique after assessing lid tension, the amount of skin and fat, and cheekbone structure.
Who is it for?
- people with pronounced, persistent bags that do not go away during the day,
- people with lax, crepey lower-lid skin,
- people whose bags run in the family and appeared at a young age.
If the bags are worst in the morning and improve during the day, the cause may be swelling – thyroid, kidney problems and allergies should be ruled out before considering surgery.
Procedure and recovery
The operation is done under local anaesthesia, sometimes with additional sedation, and usually takes 1 to 2 hours. Swelling and bruising after lower-lid surgery tend to be more pronounced and last a little longer than after upper-lid surgery – usually 2–3 weeks. Skin stitches (transcutaneous approach) are removed after about 5–7 days. Temporary swelling of the conjunctiva, watering or dryness may occur. See recovery after blepharoplasty.
Risks
Besides the usual eyelid-surgery risks (haematoma, infection, asymmetry, dry eye), lower-lid surgery carries a risk of changing lid position: a lowered lid margin, visible white below the iris or an outward-turning lid (ectropion). This is why assessing lid tension and choosing the right technique matter so much. More on risks and contraindications.
Frequently asked questions
Will the bags come back?
Removed or repositioned fat usually does not regrow, so the effect is long-lasting. Skin and facial tissues continue to age, however.
Will surgery remove dark circles?
Not if they are caused by pigmentation. A shadow caused by a hollow (tear trough) can be partly reduced by repositioning fat. Pigmentation needs other treatments.
Can upper and lower lids be done together?
Yes, if the doctor considers it safe. See blepharoplasty.
This page is for information only and does not replace a medical consultation. Eligibility for any procedure is decided by the doctor after an examination.
