Eyelids, Bags and Shadows (blepharoplasty)

Q. I would like to lift my upper lids and, if possible, to eliminate the shadows, but without visible scars. Is there a kind of surgery or a treatment that can tackle these problems without leaving visible scars?

A. Blepharoplasty (eyebag removal) is a surgical operation that allows the correction of defects such as drooping upper eyelids, fat bags and dark shadows, which can make the eyes look tired and the face older, sometimes interfering with vision.

Cosmetic surgery on the eyelids consists of removing the excess skin and fat inside the upper and lower eyelids and in repositioning the drooping eyebrow.

In the most common surgical procedure, which consists in contouring the orbital muscle and the fat bags and in removing the excess skin, the incisions are made in the folds of the upper and lower eyelids and they are practically invisible.

If there are only fat bags in the lower eyelid and it’s not necessary to remove excess skin, the surgeon can perform a procedure called ‘transconjunctival blepharoplasty’, without the need to make external skin incisions.

Q. What causes the eye bags to form? How can they be eliminated or improved?

A. The so-called “bags” under the eyes are due to the emergence of periocular adipose tissue caused by the relaxation - for congenital or ageing reasons - of the supporting structures such as the skin, the orbital muscle and the orbital septum. There are no creams or beauty treatments capable of reducing or eliminating this kind of blemish. The only remedy is a surgical one which consists of removing the excess skin and fat by means of an incision that can be made inside the eyelid. The incisions are always hidden in the fold of the eyelids.

Q. Is it possible to change the shape of the eye?

A. Yes. Blepharoplasty can modify the shape of the eyes by lifting and/or repositioning the lateral corner of the eyes (which is known as cantoplasty and canthopexis). This kind of surgery is usually requested by patients who wish to have “asian-like” features.

Q. What causes dark shadows and how can they be reduced?

A. Dark shadows are caused by the ageing process and by other congenital factors (very thin skin, lack of subcutaneous fat, etc.) which make the wine red orbital muscle show through, thus creating some sort of dark shade under the eyelid.

Sometimes, this phenomenon is accompanied by the presence of fat bags caused by the laxity of the structures supporting the periocular fat. In some cases, dark shadows can be improved by the lipofilling treatment which consists of taking small quantities of fat by means of a thin needle or a cannula. This fat is then injected into the sunken area or by a graft of adipose tissue or, if there are fat bags too, also by blepharoplasty surgery with lowering of the excess fat tissue.

However, if the shadows are mainly due to hyperpigmentation, it is preferable to use good cover-up / concealer.

Q. Can blepharoplasty be performed under local anesthetic and in outpatient care?

A. Yes. Blepharoplasty is normally performed under local anesthetic with sedation which means that you will be awake but relaxed and insensitive to pain. You will be seen as a daycase in outpatient care. If the eyelid contouring is particularly challenging or performed in association with other surgical operations (e.g. a face-lift), a general anesthetic will be needed with one or two-day hospitalisation.

Q. After surgery, how long should I wait before wearing glasses or contact lenses?

A. 24 hours after the operation, you will be already able to wear glasses whereas, as for contact lenses, you’ll have to wait about one week.

Q. How long should I wait before exposing myself to the sun or to ultraviolet lamps?

A. As with all scars, it is not advisable to go out into the sun during the first 6-12 months after the operation because hyperpigmentation would make the scars more visible. However, one month after the operation, sun exposure will be fine as long as sensible precaution is taken with protective eyewear and high factor suncream.