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  • Writer's pictureDr. Akshay Nair

Time to pack those under eye bags away!

Updated: Apr 13, 2021


A lot of my patients constantly ask me what to do about puffiness around the eyes and under-eye bags and pouches. I decided to have a chat with a renowned, young dashing oculoplastic surgeon Dr.Akshay Nair to shed some light on it. What is a blepharoplasty?

This is one of the most common questions that and an oculoplastic surgeon or a dermatologist's face. Essentially blepharoplasty is a surgery that is performed to improve or enhance the appearance of the eyelid. This can be performed on the upper eyelid or the lower eyelid depending on the requirement of the individual.


What happens in a blepharoplasty?

In an upper eyelid blepharoplasty, the excess skin on the upper eyelid is removed surgically in a precise and aesthetic manner and the eyelid fold is re-created to give a fresh, rejuvenated, and younger appearance. In a lower eyelid blepharoplasty, the under-eye bags are removed or sculpted to give a fresh, rested look to the face.


But how does one know if they need a blepharoplasty and what causes these changes on the face?

Let’s discuss this step-by-step. As we age, the upper half of our face tends to droop and sag due to the effect of gravity, the lack of support under the skin in the connective tissue, and photodamage. In addition, as we age, the amount of fat that is stored under our skin and subcutaneous tissue also reduces. As a result, parts of the face that once appeared full and supple - such as the eyelid or the cheek slowly appear deflated and hollow. This results in a lot of loose skin and in the area of the upper eyelid, this is typically seen as eyelid hooding or a roll of excess skin that overhangs the upper eyelid and can even hide the eyelid crease. In some cases, the amount of skin is so much that it can even affect peripheral vision. This is something that can be seen in the late 30s, the 40s, and the 50s. So, in an upper eyelid blepharoplasty the excess amount of skin and subcutaneous tissue is measured and accurately removed; the eyelid fold or the crease is restored and the position of the eyebrow may also be pulled up slightly to give a more natural and rejuvenated look.


Now about the lower eyelid – ‘puffy eyelids’ or ‘eyelid bags’ or loose sagging skin under the lower eyelid - all of these are some of the common conditions that we see in our clinic. Very often these patients may have been recommended a filler injection or threads or laser on the face as a remedy to get rid of these. But before deciding on a particular treatment, we must know that there can be multiple reasons why lower eyelid bags can appear - the most common being age and genetics.


In most cases, people with lower eyelid bags can recollect their parents or older relatives having a similar condition. This is a genetic trait that is seen across generations.


These ‘puffy eyelids’ can often give a tired look a look that people call ‘swollen eyes’ or ‘drunken eyes’. And this can be extremely disturbing. The reason for these bags is the weakening of a structure called the ‘orbital septum’ in the lower eyelid. Now, the fact that generally surrounds and protects the eyeball, starts protruding through this weakened septum and bulges out. This fat that bulges underneath the skin of the lower eyelid is what gives the appearance of under-eye bags.


Very rarely they can be other reasons for the appearance of eyelid bags as well such as thyroid-related problems or kidney ailments which is why it is extremely important to suddenly investigate and check if you may be suffering from any of these conditions as well before directly deciding on getting surgery done.


What about under-eye hollows or dark circles - can a blepharoplasty help?

Many times, dark circles or under-eye hollows are not seen in isolation. They are often seen along with some other signs of aging or photodamage on the skin. In some cases, a blepharoplasty may be combined with a filler injection a few weeks after the blepharoplasty to give an ideal result. In some cases, your doctor may recommend only a filler injection in the under-eye area to improve the appearance of dark circles. There is no one single treatment that can completely solve all problems and therefore based on the appearance of the eyes, the treatment is customized.


Is a blepharoplasty a painful procedure?

No. Typically blepharoplasty is a surgical procedure that is done under local anesthesia. This means that a medicine that causes numbing and loss of pain sensation is given in the eyelid area before starting the procedure. While you may feel a slight sensation of touch or you may be able to understand that your doctor is performing a procedure the sensation of pain and pressure will not be perceived by you. In addition, sedation may also be offered which can put the patient to sleep for the duration of the procedure. After the surgery your doctor will typically prescribe some painkillers that will take care of the swelling as well as the pain.


How long is the recovery following a blepharoplasty?

Typically following a blepharoplasty, the pain and the swelling subsides within the next 2 to 3 days after surgery. However, some bruising may persist for a few more days after surgery. In the case of an upper eyelid blepharoplasty, sutures are removed typically one week after surgery. In the case of a lower eyelid blepharoplasty there are no sutures or scars on the skin and therefore recovery can be quicker. While one can expect to resume their normal day-to-day activities and their daily routine within a week following the surgery, healing will take place over the course of the next 2 to 3 weeks. One should ideally wait for at least a month after surgery to observe the complete effect of the blepharoplasty on the face.


Are there any scars or marks on the face in a blepharoplasty?

In the case of an upper eyelid blepharoplasty, the surgical incision is hidden under the eyelid crease or the fold of the upper eyelid. In the case of a lower eyelid typically this is performed transconjunctivally. This means that the surgery is done from the inside of the eyelid - this eliminates any scar or an incision with a blade or any mark on the skin of the eyelid. Essentially, this surgery performed through a hidden scar - through the space between the lower eyelid and the eyeball. Therefore the surgery does not leave behind a mark or a scar on the face - the result is a natural, aesthetic, and scarless recovery.



Who is qualified to perform a blepharoplasty?

Usually, a blepharoplasty is performed by surgeons who have specialized training in aesthetic and cosmetic surgery. This includes oculoplastic surgeons - who are essentially eye surgeons or ophthalmologists, who have intimate knowledge about the eyelid and the surrounding area and additionally have received extensive training in the surgical procedures of this area of the face.


How long does a blepharoplasty surgery last?

Typically, a blepharoplasty surgery lasts between 60-90 minutes. As mentioned earlier since this is done under local anesthesia most patients describe this to be a pain-free experience.

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