ABC7’s The More in the Morning team spoke with Dr. Michael K. Kim, Board-Certified Plastic Surgeon, to discuss Lower eyelid surgery, or blepharoplasty, which is a procedure that removes excess skin and fat, repositions fat, and tighten your skin around the lower eyes.
Fine lines, wrinkles, or crepey skin. These are the major signs of skin aging all over the body. The eyes, with their multi-directional movement, constant exposure to UV light, and extremely fine and thin skin on the lids, is one of our most expressive organs of communication and emotion, and by default then, the most seemingly vulnerable to the effects of time and gravity.
Lower eye bagging, however, is a specific issue that arises not only from the loss of elasticity but changes to the fatty deposits below. These can arise from the 3 fat pockets, normally found under the eyeball, to become altered by the movement of other tissues and supporting structures. For example, the cheek fat can descend and pull down tissue to create a hollowing effect. Also, The fat pads themselves can move downward as muscular structures and skin loosening allow for gravity to do its work.
As a solution, temporary hyaluronic acid gel-based fillers such as Juvederm, Sculptra, and Restylane are often used to alleviate the hollows that are formed, depending on an appropriate scenario. However this solution is temporary, and cannot address heavier fat pad bagging beneath eyes. Often this solution is used in conjunction with Lower eyelid surgery or Blepharoplasty.
Lower Eyelid Blepharoplasty
Lower eyelid surgery, or blepharoplasty, can remove excess skin and fat, reposition fat, and tighten your skin. Surgical options offer a more permanent solution that can treat more of the components and structural issues that are contributing as a whole to the lower lid sagging or bagging. In much the same way as the upper eyelids are influenced by brow position, the lower eyelid appearance is influenced by the cheek. This makes lower blepharoplasty a technically more demanding procedure.
An incision is made either directly below the eyelashes or within the inner aspect of the eyelid itself. Depending on what is required for you, the fatty bulges can be redistributed, removed, or in the majority of cases a combination of both, to achieve a more youthful appearance to the lower eyelid. The structures supporting the lower eyelid are also tightened, to deliver a more youthful lower eyelid.
If a more dramatic effect is desired than fillers can provide, a deeper restructuring that treats the problem of excess fat and bags in combination is needed. Older surgeries involved simply removing this excess fat, which improves the undereye bag but does nothing to improve the hollow area that forms beneath the bag. Fat removal can help the patient to appear less tired and more alert but sometimes can have a downside. In reality, removing the fat alone can sometimes add to aging changes and more prominent hollows. Fat removal is often only one part of the solution.
For the hollow underneath eye bags, fat can also be repositioned rather than removed completely. Part of the solution in lower eyelid blepharoplasty surgeries is to use fat to an advantage to improve the shadows, hollows, and contours, rather than simply removing and discarding it. Taking fat from one area and repositioning it addresses both the bag and the hollow area underneath it. This procedure treats dark circles and hollows better than hyaluronic acid fillers — but it requires a bigger commitment to surgery. When we move eye socket fat into the cheek, we’re crossing anatomic boundaries, which can result in longer healing time. But the final effect can have dramatic rejuvenating results.