Why Eye Bag Removal in Prominent Eyes is Best Done by Specialist, and the Right Time for Revision

Author: Amiya Prasad, M.D.

Thank you for your question. You submitted several photos and you state in your question that you are 2 weeks after lower eyelid surgery and you are ready to think about revision surgery. And you state that there visible incisions that were placed too low, that you feel that there bumps and that you feel that you have bags. Well, certainly I can share with you my approach to patients like yourself who come to our practice seeking this type of revision surgery as early as two weeks. To give you a little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon.

I have been in practice in Manhattan and Long Island for over 20 years. A big part of my practice is to do revision eyelid surgery for patients who come from all over the world. So I’ll give you an idea of what my thinking is of how your surgery was done and then what I think is potentially an opportunity but I think that from the word go, I would say you are probably a little bit too early to consider surgery. Here’s how I think through this process when patients come to me. First I want to make sure that the eye is protected. If the eye is in a compromised position and there is an issue with the health and integrity of the eye that’s not responsive to drops and ointments, then early surgery is warranted.

There have been many situations where people have come where their eyelids were completely everted called ectropion where they had severe dry eyes so they couldn’t put enough drops and ointment and we had to move in and do things sooner. In your situation, it doesn’t look like the case. Your situation is actually an anatomic challenge. So basically, the situation was already a challenge from an ophthalmic structural point of view. And what do I mean by that? Well one, you have relatively prominent eyes which means that the lower eyelid is in what’s called a relative negative vector. So any procedure done from the outside puts you in a little bit of higher risk of eyelid retraction. In addition, because of the anatomy and the position of the lower eyelid, there’s definitely an understandable reason as to why there is this appearance of bags.

Now, just to finish that thought, typically for someone like yourself, I would have chosen, and again, this is a stylistic issue. It’s not necessarily you’re physically doing something wrong but rather, I typically do this procedure from the inside of the eyelid called a transconjunctival blepharoplasty. When someone has prominent eyes, for an oculoplastic or oculofacial plastic surgeon, it’s something that we are very familiar with because we deal with thyroid eye disease and other conditions where people’s eyes are very prominent so the dynamics are very important. The challenge is that it’s also technically demanding to operate on someone who has prominent eyes from the inside as well. So it’s also maybe a reason why a lot of surgeons prefer to do this from the outside. Now that being said, as far as the concern about the incision being low, often when people are swollen, the incision can look a little bit further away from where it was originally placed. So, you can probably wait to allow the swelling to resolve because the incision placement may be not as displaced as you may think. In addition, when you have very light skin and you have other lines in that area, very often the incision tends to blend.

Why Eye Bag Removal in Prominent Eyes is Best Done by Specialist, and the Right Time for Revision

So even if it is too low, it tends to heal well enough that it doesn’t become justifiable to do anything else. As far as the bumpiness of the incision, that is also normal. Two weeks out, it is not unusual. I always tell people that the first month after surgery, it’s called the proliferative stage. This is the stage where the body is creating a lot of blood supply and a lot of collagen and things can get bumpy and this applies to any incision regardless whether it’s an eyelid incision or facelift incision or any other kind of incision. So that would probably resolve with observation.

As far as the bags are concerned, most likely you are dealing with a lot of swelling and swelling has to be resolved to differentiate residual fat, redundant skin and to differentiate from swelling. So generally, it’s advisable to allow at least 6 months to go by. Since the integrity of the eyelid and the position of the eyelid is not really an issue but it’s really about the aesthetics, you have time to consider something revisional later.

I think that for now, continue your follow-up care. Discuss these issues. Let your doctor guide you as to how to manage these issues. If you chose your doctor to do the procedure, certainly, you already have established a certain amount of trust. And so, at least have this discussion and see if you can get some guidance. Your doctor may recommend something like massage to help expedite and fluid that is sitting in one area that may not move as easily with normal eyelid movement. I mean, there are a couple of things you can to do to help enhance the healing process but understand that the healing process does require time.

So I hope that was helpful, I wish you the best of luck and thank you for your question.

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