Removal of Under Eye Bags

Lower eyelid “bags” and “dark circles” are two of the most common reasons patients see Dr Maleki for a cosmetic surgical consultation. The aging process will be significantly different depending on the anatomical differences between each individual, however generally as part of normal aging, a process called lower lid fat prolapse occurs in many patients.  In essence, what occurs is the fat that should normally be in the eye socket bulges forward in the lower lids because of a weakness in the connective tissue that keeps the fat back. This gives the appearance of eye bags or dark circles in the lower lids, making the patient appear more tired and aged.  This can also be seen in younger patients with a strong family history of “baggy” lower eyelids.

To reverse this process there are multiple approaches that can be taken. During your initial consultation, Dr. Maleki will discuss the various treatment options and create an individualized plan for you.

Many younger patients with mild fat prolapse are able to avoid or delay surgery. In the hands of an experienced injector and in properly selected patients, dermal fillers in the tear trough can mask the appearance of dark circles by filling the hollow at the lid/cheek junction.

However, for older patients with more significant fat prolapse or patients with excessive skin and wrinkling, dermal fillers are not recommended. These patients would see the best results with a lower lid blepharoplasty procedure to remove the excess fat and tighten the loose skin. Lower lid blepharoplasty can dramatically improve the eyelids, restoring a rested and refreshed look to the eyes and the face in general. Also, when done by someone who has the superior training and experience in cosmetic eyelid surgery such as Dr. Maleki, lower lid blepharoplasty can last for decades.

How is a lower eyelid blepharoplasty performed ?

Depending on the patient’s specific condition, one of two approaches can be taken for lower lid blepharoplasty surgery:

1)  Transconjunctival lower lid blepharoplasty involves making the incision behind (inside) the eyelid and removing the prolapsed orbital fat from the inside. The advantage of transconjunctival blepharoplasty is that we avoid an external skin incision.  If the patient also has loose or redundant skin, we often combine transconjunctival blepharoplasty with co2 laser resurfacing which uses laser energy to tighten the skin. Only patients with certain skin types are candidates for laser skin resurfacing and Dr Maleki will discuss this with you at your consultation.

2) Transcutaneous lower lid blepharoplasty is the second type of lower lid surgery where an external skin incision is made about 1-2 mm below the eyelashes on the lower eyelids. This gives access to the fat pads and allows for removal of skin. This procedure is performed on patients who are not good candidates for laser resurfacing.

Sometimes fat transposition is performed at the same time as lower lid blepharoplasty if there significant hollowing at the lid/cheek junction. Again, Dr. Maleki will discuss this with you at your initial consultation.

Recent innovations in CO2 laser technology has made blepharoplasty surgery more patient friendly by reducing swelling and allowing for rapid recovery. In addition Co2 laser resurfacing can be applied to the rest of the face at the time of surgery to smooth out other wrinkles that may bother you.

I am interested! How should I proceed?

If you are unhappy with the appearance of your eyelid and are tired of people telling you “you look tired” consider a private consultation with Dr. Maleki to get informed about your treatment options. He will make sure to find a treatment that meets your specific and unique needs. You do not need a referral from a doctor. ( You can call the office directly to schedule an appointment or email us at Please note there is a consultation fee for all cosmetic appointments with Dr. Maleki.

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