Eyebag Surgery – Lower Blepharoplasty

INTRODUCTION

Eyebag - removal surgery Eyebag
  • Eyebag is caused by excessive fat accumulation and also laxity of skin and orbital septum which contains the bag of fat. Lower blepharoplasty can address both eyebag and lower lid skin excess and laxity.
  • There are 2 methods to remove eye bags:
    • Transcutaneous/ Subciliary lower blepharoplasty
    • Transconjunctival lower blepharoplasty

 

Subciliary Lower Blepharoplasty (External Method)

  • This method is suitable for patients with excess lower eyelid skin and fat pocket. Removal of fat alone would result in gathering of excessive loose skin.
  • A fine cut is made just below the lower lid eyelashes. A small strip of excess skin and fat is then removed.
  • Those patient with severe laxity of the lower lid may need additional tightening procedure to prevent drooping of the lower eyelid post surgery (lateral canthopexy or lateral canthoplasty).
  • The scar below the eyelashes often becomes imperceptible after about 3 months.

 

Transconjunctival Lower Blepharoplasty (Scarless Method)

  • This method is suitable for young patient with no skin laxity/excess. The fat pocket is removed via a small cut in the back of the lower lid leaving no scar on the exterior.

 

COMPARISON OF SUBCILIARY VS TRANSCONJUCTIVAL LOWER BLEPHAROPLASTY

Subciliary Lower Blepharoplasty (External Method)Transconjunctival Lower Blepharoplasty (Scarless)
Photo
Lower Blepharoplasty - Eyebag RemovalLower Blepharoplasty – Eyebag Removal
Lower blepharoplasty - Transconjunctival - Scarless Eyebag Removal Lower blepharoplasty – Transconjunctival – Scarless Eyebag Removal

Side profile of the lower lid showing the cut on the inner (conjunctival) surface.

ScarFaint scar – below eyelashScarless (incision hidden on the inner surface of the lower eyelid)
What is done
  • Removal of eyebag
  • Removal of lower lid skin excess.
  • Lateral canthopexy to tighten lower lid laxity (optional)
  • Fat redistribution to smoothen the contour of the lower eyelid (optional)
  • Laser resurfacing of wrinkled lower lid skin (optional)
  • Removal of eyebag
  • Fat injection to smoothen the contour of the lower eyelid (optional)
  • Laser resurfacing of wrinkled lower lid skin (optional)
Suitable patientAll patients with eyebag.Younger patient with eyebag, and no lower lid skin excess or laxity.
Suture Removal1 weekNone

 

 

CONCURRENT PROCEDURES:

The following procedures are commonly combined with lower blepharoplasty :

 

METHODS OF EVALUATION OF LOWER LID SKIN LAXITY

  • It is common to remove excess lower lid skin after removal of eyebags. If there is pre-existing laxity of the lower lid, removal of skin excess can cause the lower lid to droop and turn outwards away from the eyeball (ectropion).
  • There are two ways to assess lower lid laxity :
    • Pinch test (snap-back)
      • The lower lid skin is pulled downwards towards and allowed to snap backwards. To check the laxity of the lower lid (tarsal laxity).
    • Distraction Test
      • Pull the lower lid skin away from the white of the eye (sclera). A gap more than 8 mm denotes laxity (tarsoligamentous).

Lateral Canthopexy

  • It is a procedure done to tighten the lower lid to prevent ectropion. Non-absorbable suture is placed over the lateral corner of the lower lid (lateral canthus) and tied to the sidewall of the bony socket of the eye (lateral orbital rim).

 

DESCRIPTION OF PROCEDURE

Transconjunctival lower blepharoplasty (scarless method)

  • The lower lid is pulled downwards and small cut is made on the inner (conjunctival surface).
  • Resection of excess medial, central and lateral fat pad.
  • Wound closure with absorbable sutures.
  • Adjunctive procedure :
    • Fat transfer to lower lids
    • Laser skin resurfacing treatment to lower eyelid/ face
  • Surgical duration: 1 hour
  • Day Surgery (home on the same day)

Subciliary Lower Blepharoplasty

  • Pre-operative marking to determine amount of lower lid skin to be removed.
  • A cut is made just below the eyelash margin.
  • Dissection to expose and remove the excess lower lid fat pads (eyebag).
  • Excess lower lid skin is trimmed.
  • Wound closure with very fine non-absorbable suture.
  • Adjunctive procedure :
    • Lateral canthopexy to tighten the lower lid and prevent ectropion.
    • Fat transfer to lower lids
    • Laser treatment to lower eyelid/ face
  • Surgical duration: 1-2 hour
  • Day Surgery (home on the same day)

 

ANAESTHESIA

  • Combination of local anaesthesia with IV sedation for maximal patient comfort.

 

POST OPERATIVE CARE

  • Mild discomfort to be expected include:
    • Swelling usually resolved by 1 week.
      • In rare instances swelling may take several weeks to resolve.
      • Avoid exertion and rest 30 degree head up to hasten resolution of swelling.
    • Bruising usually resolved by 2 weeks.
    • Tearing
  • Post-operative medications:
    • Antibiotic ointment to be applied regularly 3-5 times a day
    • Antibiotic eye drops 3 times day
    • Oral antibiotics
    • Analgesics (pain relief) and anti-swelling medications
  • Removal of suture at 1 week.
  • Resumption of light exercise for 3-4 weeks.
  • Refrain from wearing contact lens up to 4 weeks post-surgery.

 

RISK AND COMPLICATION

  • Bleeding/ Haematoma (blood clot accumulation)
    • Avoid exertion post-operative.
  • Infection
    • Very rare
    • Avoided by clean (sterile) technique during the surgery.
  • Ectropion/ Scleral show
    • This is prevented by performing lateral canthopexy.

 

FINANCIAL COUNSELLING

  • Lower blepharoplasty for removal of eyebag is considered as a cosmetic surgery. The correction of ectropion is a medical procedure.

 

During the consultation, our plastic surgeon would guide you to choose the best eye bag removal surgery methods used most commonly by some of the top plastic surgeons in Singapore and Korea.