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What procedure is needed to get rid of bags under the eyes?

Q:

I'm only 24 years old and have been struggling with bags under my eyes.  What would be the best option(procedure) to get rid of these and would it be an expensive surgery to be done by a surgeon in the New York area?

A:

At 24, any bags under your eyes are probably congenital and caused by excess fat. You are one of the very few who would most likely benefit well from a transconjunctival lower blepharoplasty to remove this excess fat. The only way to know the cost is to consult someone who specializes in this. However, remember that you are doing this to look better. The cheapest is usually not the best option. You need experience to determine what you need and to do the procedure well.

R. T. Buchanan, MD

A:

A very common aging change in the lower eyelids is the development of bags, which are in most cases due to an outward bulging of the fat pads behind the lower lids. These bags of fat can be improved by conservative removal through an invisible incision on the inside of the lower lid (trans-conjunctival approach) in patients that do not require skin excision, or through the under-eyelash (sub-ciliary approach) in patients that are having some excess lower lid skin removed.

As with skin removal, I believe that the reduction (NOT total removal) of lower lid fat pads should be conservative. Excessive removal of lower lid fat pads results in a hollowed-out appearance that makes blepharoplasty patients look tired or even ill. I see quite a number of eyelid surgery patients who require structural fat grafting of the lower lids to improve that very problem following an over-aggressive lower blepharoplasty in the past.

In some case lower lid bags can be improved by repairing or reinforcing the soft tissues that normally hold them back. Additionally, excessive lower lid fat can sometimes be mobilized and transposed inferiorly to fill in periorbital hollows or depressions such as the tear trough at the medial junction of the lower lid and cheek. Some eyelid bags involve redundant muscle tissue which must be removed and/or repositioned, usually in patients who are in their sixties or older. This is performed through an under-eyelid (sub-ciliary) incision which is extended laterally into the crow's feet area.

At 24 you may not be a candidate for this surgery. A consultation (or perhaps multiple consultations) may help you decide the best option for you.

M.M. Law, MD

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