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Tired, sad appearing eyes and those eyelid bags…What can I do? An Informative Essay.

A very common reason patients come to our Orange County office in Aliso Viejo is because of tired, sad appearing eyes.  More often than not the cause is directly attributed to the lower eyelid area, more so than the upper eyelid area, and the tired sad appearance of the eyes are typically the result of lower eyelid bags.

Unfortunately, expensive eye creams and eyelid exercises do not work to correct lower eyelid bags because these measures do not effect or even directly touch eyelid bags.  That is, eyelid bags are composed of fatty tissue, and this fatty tissue is located underneath a muscle (the one you would be exercising), and this muscle resides underneath the skin that you would be putting eyelid creams on.  So, to review the layering is skin, muscle, and then eyelid bag (fatty tissue).

Specifically, for a cream to be effective the cream would have to go through the skin, then work its way to and through the underlying muscle and then be absorbed into the fat bag, and then be evenly distributed throughout the bag, and then somehow miraculously dissolve or reduce the fat bag to the precise amount you want or need.  That would be quite an accomplishment!  Truly, no matter what “information” or claims that are found in a magazine or online, or in a sensationalized advertisement (which are commonly found on Facebook or Yahoo), no such cream or treatment exists.

Since lower eyelid bags are fatty tissue, it is helpful and an advantage for patients to understand why eyelid bags are even there.  It is best to think of an eyelid bag as something similar to a hernia—because anatomically it is similar to a hernia.  You may or may not recall what a hernia is, but simplistically speaking, a hernia is some anatomical structure that is “pooching out” that should not be.  The structure is “pooching out” because some other structure that is supposed to be holding it back has weakened through aging, or if earlier in life possibly due to genetics, or sometimes through injury.  As an aside, when eyelid bags are found in patients in their late teens or early twenties it is typically due to a genetic weakness of a structure called a septum.

Additionally, you may recall, hernias are commonly found in the abdomen and groin area.  And as an example, if some Facebook or Yahoo advertisement recommended a cream to correct your abdominal hernia, I’m sure this would raise an eyebrow and you would more often than not think what they are claiming just does not sound right and seems veryfar-fetched.

Similarly, this should be the thought process with eyelid bags because the issues are anatomically similar.  Consequently, it is helpful to really understand what the underlying cause of eyelid bags are so you can avoid spending money on creams and other treatments that simply will not work.  Moreover, we have found that many of these incredible results seen in eyelid creams advertisements found online (on Facebook and Yahoo) are either “Photoshopped” or the pictures were stolen from websites where the patients had surgery or laser treatments.

The definitive correction for eyelid bags (or any hernia) is through a surgical procedure. The procedure for eyelid bags is called a lower blepharoplasty (pronounced blef-a-row-plas-tea).  This procedure has experienced major advancements through the years with the newer innovations offering excellent, natural and reproducible results, while the older techniques, which are still in common use today, frequently hollow-out the eyes and alter the patient’s natural eyelid shape.  Results not seen with the newer techniques.

Only newer, more sophisticated techniques are used by myself at Refreshed Aesthetic Surgery and are based on our Facial Plastic Surgery specialty’s enhanced understanding of facial aging and advanced surgical techniques.  These techniques have been published and presented by myself at national meetings.  The techniques are based on smoothing out the prominence of the eyelid bag while simultaneously filling in the “groove” commonly seen lying just underneath the eyelid bag.  Sometimes it is helpful to look in a mirror to familiarize oneself with this “groove” or hollowness that resides just underneath the lower eyelid bag. The technique I use is commonly called fat repositioning.

There are some non-surgical options to rejuvenate tired, sad appearing eyes such as placing filler into the groove and adjacent areas located just underneath the eyelid bag.  But, it should be remembered and understood that these non-surgical options do not solve the underlying problem, they only hide and camouflage the eyelid bag.

Nevertheless, these treatments can be effective in a small subset of patients and will not work well in others.  For those that are reasonable candidates for a filler, the procedure must be performed in a specific fashion for the treatment to be aesthetically effective and not make the problem worse.  Unfortunately I commonly have patients, treated elsewhere with filler, come to my office to have these fillers dissolved.

Another non-surgical treatment often asked about for the treatment of eyelid bags is laser resurfacing.  Lasers are extremely effective at improving the quality of skin through collagen building, smoothing wrinkles, tightening skin to a certain point, and removing brown spots and discolorations.  However, lasers treat only the skin layer.  The laser cannot safely go through the skin, then through the muscle and then interact with the fat bag.  Therefore, laser resurfacing can often complement surgery for eyelid bags by improving the overlying skin but a laser treatment cannot directly treat eyelid bags.

Lastly, there are many choices for surgeons who do eyelid surgery, but it is important to remember when deciding on your surgeon to look at before and after results performed by the surgeon, what technique are they using, AND to make sure that your surgeon is not only board certified but board certified in a plastic surgery field recognized by the Medical Board of California.  The Medical Board of California recognizes only two boards for plastic surgery and this can be inspected by clicking this link to the Medical Board of California’s website.  Of note, the Board of Cosmetic Surgery, which is commonly marketed, is not recognized by the Medical Board of California and there is no board for oculoplastic surgery; it is a term coined by ophthalmologists who do eyelid surgeries too, they are not board certified by the American Boards of Facial Plastic and Reconstructive Surgery or Plastic Surgery.

Click this link to visit our photo gallery showing several before and after results of lower eyelid bags treated using the fat repositioning technique.

Timothy R. Miller, M.D.

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"I opened this state-of-the-art cosmetic surgery office in Aliso Viejo, California, to provide patients seeking aesthetic services with something unique. Our mission is to educate and honestly assess each patient, offering the finest aesthetic treatments available so you will look and feel Refreshed." Read More »

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