How Factors like Sinuses and Allergies are Considered in the Options of Eye Bag Surgery

Author: Amiya Prasad, M.D.

I'm hoping that someone can offer advice on suitability for lower eye bag surgery and what type? I'm a 38 year old woman & always had dark circles under my eyes. Over the last year, I have noticed it worsening and bags forming (more swollen on some days) my eyes feel tired and itchy, there is pressure around my orbital socket & my nose also blocks. I have (managed) hypothyroidism and have tested negative for Sjogren's, liver and kidney problems.

I have been prescribed anti allergy nasal spray (effective on nose, but not eyes). Can anyone offer advice, the bags keep growing - Many thanks Thank you for your question! You're 38 years old and you've been concerned about the appearance of puffy bags under your eyes and you're asking about the best approach to dealing with this. It's also very good that you also included with your question some background about your medical work-up and that you do have some issues related to sinus and allergy. At this point, I can certainly understand how despite the management of the underlying eye or nose or allergy situation, you're concerned that the bags keep getting bigger. So let's start by just understanding the issues that may not be fully addressed when you are being seen by medical doctors. As a cosmetic oculofacial plastic surgeon, I perform a lot of eyelid surgery and I have a lot of experience with this type of situation, I've been in practice for 20 years. So let's start with what we see in the photos you submitted. Lower eyelid puffiness is something called lower eyelid fat prolapse.

Lower eyelid fat prolapse is the fat pockets that are around the eyes that pushes forward. Very often, it is a genetic issue and that naturally it just happens. A lot of times it is not something that is not related to sinus, allergies and other things. Now with that being said, the eye and the nose area, the nose, the sinuses and the orbit, the space around the eyes, all converge to a common area called the cavernous sinus where fluid drains. When there is sinus congestion and allergies, it's almost like there's a traffic jam going back to that common location behind the eye. Because of that, the fluid tends to back-up into the soft tissue around the space around the eyes as well as the fat. So you can imagine that no matter what happens, you would still have some fluid that will be an issue given that type of scenario and so, ongoing progression of the fatty pockets will be related to some degree to the relapsing of fluid. Nonetheless, the basic anatomic issue is still the same.

And that is that there are fat pockets that are pushed forward and causing this untightly bulges. The typical solution that I offer to my patients who come to my practice in the similar situation are as follows: first, we would try to maximize all medical therapy to try to optimize the surgical procedure that we intend to do. Surgery naturally causes swelling and when people have issues with swelling prior to surgery, very often, that does a significant role in how fast the swelling clears after the surgery.

How Factors like Sinuses and Allergies are Considered in the Options of Eye Bag Surgery

So that being said, going to the eye doctor, the ophthalmologist to manage any eye allergies issue, staying in touch with your ear, nose, throat doctor or allergies to treat allergies and sinus and making sure everything is stable. That being said, there are options on how to address the lower eyelid fat prolapse and they are surgical options. One is called a transconjunctival blepharoplasty and that's a procedure where the fat pockets are addressed from the inside of the eyelids and the other is called a transcutaneous blepharoplasty and that's an approach where the incision is made underneath the eyelashes from an external approach. From my experience, when people have issues with swelling, our goal is to minimize the trauma and respect as much the natural anatomy of the lower eyelid to optimize the circulation. From my experience, the external approach tends to be more disruptive to the drainage of the system whether it's the venous system or the lymphatic system. That leads to a more long term swelling after surgery. So in my practice, for someone like yourself, I would perform a transconjunctival lower eyelid blepharoplasty.

In so many ways, this is such an elegant approach basically going from behind the eyelid, not disrupting any of the support structure of the lower eyelid or minimally disrupting and strategically reducing and repositioning the fat appropriately. With that being said, there are other options to help with the skin quality and any other changes that have occurred to the skin but doing that all in the context of the existing issue with swelling. Sometimes, this has to be a step-wise approach. Very often, we would even consider doing an anti-inflammatory management prior surgery, during surgery and even after surgery to try to minimize the swelling afterwards. The bottom line is you do have lower eyelid fat prolapse and how to strategically address it requires also a proper physical examination. At this point I would suggest that you meet with qualified experience cosmetic surgeon who have extensive experience with lower eyelid surgery and discuss the plan and options on how to deal with issues that could come up afterwards. I think it is still related straightforward. You have already done a lot of the baseline work to manage the sinus and allergies.

These tend to be chronic conditions so it's not like you can completely resolve the entire sinus and allergy completely. It's more of like management like blood pressure management. That being said, meet with doctors with this level of experience and expertise and make a decision to proceed in a way that you feel comfortable.

So I hope that was helpful and thank you for your question!.

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