Bags under the lower eyelids are often caused by skin ageing: the fibres in the skin lose their elasticity and the skin becomes slacker. The collagen fibres soften at the same time which causes fatty fibres (which are normally found in the orbit) to be projected forwards. In younger people, bags are often caused by fat being projected forwards, although there is little excess skin.
Young people only suffer very rarely from bags under the lower eyelids: problems of the thyroid gland (Graves’ disease), congenital illnesses and smoking are all factors that can predispose patients to them.
Blepharoplasty involves removing the excess skin
Bags under the lower eyelid caused by excess skin
An incision is made just beneath the line of the eyelashes along the entire length of the lower eyelid, stretching to the laughter line at the outside corner of the eye.
The amount of skin that needs to be removed will vary from one patient to another. It is always important to find the right balance between cosmetic appearance and practicality: we do not want to remove too much skin otherwise there is a risk that patients will no longer be able to close their eyes properly. It is also not advisable to remove too much skin if patients suffer from dry eye syndrome, because it can aggravate the problem.
Some people have very slack eyelids (i.e., they can be very easily stretched if you pull on them). With these patients, there is a higher risk that the eyelid will droop when skin is removed. If during the operation we notice that the eyelid has a tendency to droop, extra lateral reinforcement is used. This means that the eyelid is also lifted towards the side. For a few weeks, your eyes may appear slightly oriental, but this effect will wear off of its own accord.
Bags under the lower eyelid caused by fat accumulation, without excess skin:
The skin is left intact, as the incision is made inside the lower eyelid. This is known as the transconjunctival technique.
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