Modern Advances in Lower Eyelid Surgery or How to Get Rid of the Bags and Circles!

Author: MUDr. Jiří Vrbický

Following a classic lower eyelid surgical procedure, you often hear or read of people complaining that their results weren't as expected. They say they still have bags or circles, or perhaps their "look" seems to have gotten worse. Read on for one doctor's perspective on why this happens and how you can avoid it if you choose lower eyelid surgery.

The most common description of lower eyelid surgery is limited only to an older surgical technique in which an excess of wrinkled eyelid skin and fat deposits under the eyelid (so-called bags) are removed. General information on eyelid surgery or blepharoplasty can be found here.

This technique can be successful in some cases, although it may not be the best choice for every patient. Often, it does not solve many problems in the lower eyelid area; here we hope to explain why.

Wrinkling of the eyelid skin and the creation of fat deposits are not the only signs of ageing centered around the lower eyelids. Cheeks also may droop when the skin's elasticity and underlying tissue is reduced. This results in a downward shift between the lower eyelid and the cheek. (Picture No.2) Compare that to a young person's face where the border between the lower eyelid and the cheek is above or level with the lower edge of the eye socket. (Picture No.1) When this border shifts under the level of the lower edge of the eye socket you get drooping cheeks. (Picture No.2) The bony lower edge of the eye socket is then only covered with a thin layer of eyelid skin. On your face this is shown by an oval-shaped hollow; often referred to as “under eye circles.” (Picture No.2)


Pic No.1: The lower eyelid in youth - Pic No.2: The lower eyelid with increasing age

When describing lower eyelid surgeries in general, especially on the Internet, doctors usually don't know about the patient's so-called round eye muscle. This is very significant for lower eyelid surgeries. This muscle keeps proper tension of the lower eyelid.  The muscle can weaken with age, and therefore its lower edge droops along with with the eyelid skin.

On the border of the lid and cheek, the muscle can be so loose that it is wrinkled, much like a too long curtain resting on the floor. In cosmetic surgery we call this “festoons.” (Picture No.3)


Pic No.3

One reason classic eyelid surgery may not produce desired results is because the reduced tension and drooping of the round eye muscle was not fixed and the drooped border between the lower eyelid and the cheek is not modified. “Under eye circles” and “festoons” stay after the surgery and sometimes they are even more visible than before. This unfavorable result after the surgery is then emphasized with flat or emptied lower eyelids.

How can modern surgical procedures help? We won't deal with technical details and surgical finesses; but instead sketch a few basic principles.

  1. The protruding fat deposits are not taken out, like in the classic method. They are bent over the lower edge of the eye socket into the hollows under the lower eyelid. This fills the hollows on the cheeks under the lower eyelids (Picture No.4)

  2. The weakened round eye muscle is tightened and sewed into the outer edge of the eye socket. (Picture No.5)


Pic No.4


Pic No.5

These procedures can remove the “under eye circles.” The lower lid is also tightened and therefore the white part of the eye is not shown below the lower edge of the iris. Using this method, even the bags on the cheeks under the lower edge of the lids (“festoons”) can be removed or reduced. The whole lower eyelid area, with the shift into the cheek gets a younger look because the border between the eyelid and the cheek is lifted to a higher position; the normal position in youth. (Picture No.1)


Before the surgery


After the surgery


Before the surgery


After the surgery


Before the surgery


After the surgery


Before the surgery - sketch


After the surgery - sketch

Are there disadvantages to these updated procedures? The usual surgical incision below the eyelashes of lower eyelid has to be lengthened more to the sides than in the classic surgery. An inconspicuous small scar remains, but is then camouflaged in the natural horizontal wrinkles that are common at the outer corner of the eyes. The healing process is hastened with pressure massages.

Final word of advice: Don't tell your future surgeon that you wish to only have lower eyelid surgery. You will avoid misunderstandings and dissatisfaction after the surgery. Describe what you don't like in the area of your lower eyelids and exactly what improvements you would like to see. Then ask if it is possible to get these results through surgery. An experienced surgeon, which can perform a variety of lower eyelid surgical techniques, can give you advice on what would be best and correct any misconceptions you may have. 

Author: Jiri Vrbicky M.D., Plasticka chirurgie MUDr. J. Vrbickeho

Updated: 2007-11-15

MUDr. Jiří Vrbický

Eyelid surgery (Blepharoplasty) - News

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