The short answer is yes with some caveats. As we have mentioned in previous blogs cosmetic surgery shares common principles with all aspects of medicine. For example, we must make a diagnosis. Once we have made an accurate diagnosis then treatment options become available to us.
Technically speaking bags or bulges below the eye at the lower lid level usually represent fat. This is not new fat. It is fat that surrounds the eyeball in all humans throughout life. This is a cushioning mechanism that functions to create a safe environment for the eyeball to function.
As we age the lower lid skin, muscle, and especially a very specialized thin layer of tissue called a septum holds the fat in its original and most optimal position. During the lower lid evaluation, we also determine if there is any darkness. This darkness can be a shadow formed by the bulging fat pocket or it can be pigmentation within the dermal layer of the skin itself. Factors such as high salt diet, problematic allergies, medical conditions such as thyroid problems can also contribute to the presence of bags under eyes.
Bags Under Eyes Treatment
These conditions have other associated signs and symptoms which must be evaluated prior to having any lower lid surgery. Once a full evaluation is completed and it is determined that the bags are result of herniated fat pocket then in my opinion a lower lid blepharoplasty is indicated. The incision for this procedure is just below the lash line carried down to the deeper tissues and a flap of skin and muscle is dissected down to the bony orbital rim.
This then allows me to open these pockets of fat and cautiously remove them to an adequate degree to remove the bag. I also like to trim the muscle cautiously to reduce some of the potential for wrinkles and crow’s feet of the lower lid. The leading edge of this flap is trimmed very judiciously and sutured in place usually with absorbable sutures so there will need to be no removal.
Once I have adequately removed the fat pockets and the bulge of fat is significantly and identifiably reduced then we can consider other treatments such as fillers, Botox, and PRF. Multiple treatments of PRF have been shown to reduce the dark pigmentation in the dermal layer of the skin.
So yes, bags can be treated provided the assessment and the analysis is accurate.
THOMAS TREVISANI, MD
BOARD-CERTIFIED PLASTIC SURGEON
MEMBER OF AMERICAN SOCIETY OF AESTHETIC PLASTIC SURGERY
