- Under-eye bags are caused by aging, genetics and lifestyle factors.
- Lower eyelid blepharoplasty is a surgical procedure that removes bags.
- Full recovery from this procedure takes 3 weeks.
- Alternatives include laser skin resurfacing and dermal fillers.
Under-eye bags are a common cosmetic issue that contribute to an older and more tired appearance. They present as puffiness below the eye or as excess folds of skin above the cheekbone, and may be accompanied by dark circles. This condition can be treated with lower lid blepharoplasty, commonly referred to as eye bag surgery or puffy eye surgery. Lower eyelid surgery is an effective means of permanently reducing the appearance of under-eye bags.
What Causes Under-Eye Bags?
Under-eye bags are primarily caused by the aging process; their development in young people is usually due to genetics.
Eye bags due to puffiness can be caused or worsened by lifestyle habits such as smoking, alcohol use, eating salty foods and not getting enough sleep.
Can eye bags be removed permanently?
If your eye bags are due to lifestyle habits, you may be able to get rid of them by developing healthier habits such as sleeping more, and cutting back on alcohol and tobacco use.
Eye bags caused by genetics or the aging process likely cannot be corrected by lifestyle changes. However, they can be temporarily smoothed with dermal fillers or permanently removed with a surgical procedure known as lower eyelid blepharoplasty.
What Is Lower Eyelid Blepharoplasty?
Lower eyelid blepharoplasty refers to a collection of surgical techniques used to remove bags below the eye.
It’s often performed in conjunction with other cosmetic surgeries such as a facelift or upper eyelid blepharoplasty, which seeks to correct drooping skin above the eyes.
How does it work?
In the past, this procedure involved excising extra skin and fat from the under-eye area, but current techniques have evolved to reposition skin and fat, and use fat transfers to restore volume loss below the eye. A combination of both methods may be used during a procedure.
Ideal candidates for this procedure will present with some of the following indications:
- Asymmetrical lower eyelids
- Sagging lower eyelids (lower eyelid laxity)
- Excess fat below the eyes
- Excess skin below the eyes
- Fat herniation (appearance of fat bulging below the eyes)
- Scleral show (exaggerated appearance of the white part of the eyes)
Additionally, you should have realistic expectations about what this surgery can achieve and be in good health.
What to Expect During a Lower Eyelid Blepharoplasty
Prior to your surgery, you will meet with your surgeon to discuss preoperative and postoperative instructions, and discuss the risks and benefits of the procedure. You may be required to be cleared for surgery by a medical doctor.
During the procedure, the surgeon administers intravenous general anesthesia and injects numbing medication into the eye area.
Next, they will make an incision just below your eyelashes or inside the lower lid, for what’s known as a transconjunctival approach. They will then reposition fat and skin, and remove excess tissue before stitching the incision closed.
Recovery and aftercare
After surgery, you will be monitored for complications in a recovery room for several hours before being released.
Blepharoplasty is an outpatient procedure, meaning it does not require an overnight stay in the clinic. You’ll need to arrange for someone to take you home from the clinic and stay with you for the first night after surgery as you will be drowsy from the anesthesia and may have limited vision due to swelling.
After the procedure, your eyelids will feel tight and sore. To achieve a healthy recovery, follow all instructions provided by your surgeon. These will likely include prescription eye drops and the regular use of ice packs and cold compresses to reduce swelling and bruising. You may also wish to sleep with your head raised and take painkillers.
The skin of the eyelids tends to heal quickly and not scar. Bruising and swelling may last up to three weeks, but you may be able to return to most regular activities three or four days post surgery, depending on how comfortable you feel in public.
Do not use contact lenses for two weeks after surgery. Avoid strenuous exercise, rubbing your eyes and smoking for three weeks afterward.
Results of Lower Eyelid Blepharoplasty
Lower eyelid blepharoplasty can significantly improve under-eye bags and puffiness. Although your skin will continue to age, diligent use of sunscreen and follow-up treatments such as laser therapy can minimize the return of eye bags.
Can eye bags return?
Blepharoplasty is commonly thought to be permanent – that the removed fat will not redevelop. However, one published paper concluded that the long-lasting results of this procedure are not supported, and that skin continues to age afterward, causing eye bags to reappear.
Risks of Lower Eyelid Surgery
Lower eyelid surgery is generally considered safe, however potential risks of this surgery include:
- Abnormal eyelid position
- Difficulty closing your eyes
- Dry eyes and irritation
- Eye muscle injury
- Need for follow-up surgery
- Skin discoloration
- Temporarily blurred vision
- Loss of eyesight (rare)
Cost of Lower Eyelid Blepharoplasty
The American Society of Plastic Surgeons (ASPS) lists the average cost of a blepharoplasty at $3,163. This does not include the cost of anesthesia or operating room costs.
Other factors that will determine the exact cost of your procedure are the city you live in, your surgeon’s experience and the surgical method being performed.
Because blepharoplasty is a cosmetic surgery, it is not covered by insurance. However, many providers offer financing plans for this procedure.
How to Find a Provider
You can find a plastic surgeon in your area who performs lower eyelid blepharoplasty by consulting the ASPS and the American Board of Cosmetic Surgery. If you find a surgeon independently of those sites, ensure that they are board-certified.
Book a consultation with a potential surgeon to see before and after pictures, discuss what kind of results you can expect, and assess whether you’re a good candidate for this procedure.
If you are not a good candidate for lower eyelid surgery or if you prefer a less invasive treatment, other procedures are available to address the loose skin and volume loss that can cause eye bags. These treatments are most effective on mild-to-moderate cases of bagginess under the eyes.
Laser skin resurfacing
Laser treatment therapy is an appropriate alternative to surgery if your eye bags are caused by aging skin. An ablative laser resurfacing treatment, also known as a laser peel, tightens loose, sagging skin below the eyes for a more youthful appearance.
Ablative lasers, however, are not suited for use on darker skin tones as they can cause skin discoloration.
Dermal fillers can be injected below the eyes to give the area a smoother, fuller appearance. While fillers may not be a good option if you have excess or herniated fat, they can restore volume loss for milder cases of under-eye bags.
Dermal fillers are a temporary solution to eye bags, usually lasting for six months to two years.
Due to their relatively lower cost, fillers are becoming increasingly popular as alternatives to surgery. According to the ASPS, the total number of filler procedures performed per year has increased in the past decade from 1.5 million in 2008 to 2.6 million in 2018, while blepharoplasties have significantly decreased.
Lower eyelid blepharoplasty is an effective solution for under-eye bags. It involves removing or repositioning skin and fat below the eye to smooth out the area and restore lost volume.
Recovery takes one to two weeks, but certain habits such as exercising and wearing contacts should not be resumed for up to three weeks.
Book a consultation with a plastic surgeon to determine whether you are a good candidate for lower eyelid blepharoplasty. If, for any reason, this procedure is not an option for you, laser skin resurfacing and dermal fillers can provide similar, albeit less permanent results.
- Garcia, C.P. & Badin, A.Z.D. (2019) Treating Excess Lower Eyelid Skin Without Incisions Aesth Plast Surg. https://doi.org/10.1007/s00266-019-01427-0
- Rostami S, et al. (2018). Blepharoplasty, lower eyelid. https://www.ncbi.nlm.nih.gov/books/NBK448181/
- Holds J. B. (2010). Lower eyelid blepharoplasty: a procedure in evolution. Missouri medicine, 107(6), 391–395. ncbi.nlm.nih.gov/pmc/articles/PMC6188239/
- Wilson, S., Daar, D., Maliha, S., Abdou, S., Levine, S. and Baker, D. (2018). Lower Eyelid Blepharoplasty: Does the Literature Support the Longevity of this Procedure? Aesthetic Surgery Journal, 38(12), pp.1289-1297. ncbi.nlm.nih.gov/pubmed/30084870