Services 》Baggy Eyelid


Aging sign usually begins around eyes. Patients presented with lateral hooding on upper eyelid or baggy eyelid on lower eyelid visit plastic clinics for correction. Upper blepharoplasty to correct aging signs on upper eyelids is introduced in another section.

In this section, method to correct lower eyelid ( lower blepharoplasty) is presented.

Before presenting lower blepharoplasty, baggy eyelid should be differentiated with smile roll. Smile roll is a bulge just below eyelashes. It is accentuated when smiling. It is caused by muscle contraction and  is a sign of young. Smile roll do not have to be treated. On the contrary, smile roll should be augmented in some aged patients.

Baggy eyelid is caused by fat protrusion. Baggy eyelid is usually associated with a depression below. The depression is named as "tear trough" or "nasojugal fold".


 

There are two ways of treating fat in baggy eyelid; one is fat excision, the other is fat transposition. The latter is quite suitable for baggy eyelid patients with tear trough. There are two ways of making incision; one is external incision ( skin incision, below left picture) , the other is internal incision ( transconjunctival incision, below right ). The latter is quite suitable for younger patients with baggy eyelid, because there is no redundant lower eyelid skin to be excised.


 

There is four methods of combination for baggy eyelid surgery. (1) external incision with fat excision. (2) external incision with fat transposition. (3) transconjunctival incision with fat excision. (4) transconjunctival incision with fat transposition. 

Below left showed a case after fat excision through external incision.





 

Fat transposition: 
The drawback of excision of orbital fat to treat baggy eyelid is that the procedure does not treat tear trough.  So that baggy eyelid is corrected partially.  The concept of fat transposition is that orbital fat (the cause of baggy eyelid) is preserved and pulled down to fill the depression (tear trough).  So that the procedure corrects the bulge (baggy eyelid) and depression (tear trough) . The postoperative curve between lower eyelid and cheek is smooth.  Below show the procedure of fat transposition.


Below picture shows the comparison between young eyelid, baggy eyelid and the appearance of excessive fat removal.  To rejuvenate lower eyelid, fat is removed only when fat is really excessive.  Otherwise, eyelid fat should be preserved and used to fill up the tear trough.

 

One of the benefit of fat transposition is that smile roll will be accentuated after surgery because fat is pulled down.  Eyelid with smile roll looks younger that eyelid without smile roll.  Below right is picture after surgery.  Arrow pointed to smile roll.


 

Below case showed the result after fat excision lower blepharoplasty performed by another surgeon.  Baggy eyelid was not corrected because tear trough was not treated.



Below show two cases of fat transposition lower blepharoplasty by external skin incision. 




 
Below show the before (left) and after (right) pictures of three cases underwent fat transposition lower blepharoplasty.  For younger cases, transconjunctival incision would not leave scar.  Recovery is quicker than skin incision. 







上方圖例:左圖是手術前,右圖是手術後。



本診所改良脂肪固定方式,手術後外表看不到縫縫,瘀青腫脹少,恢復快。
我們稱之為「無縫線眼袋內開脂肪移位術』。


如下圖。


 


另一個例子。






 其他眼內開案例介紹 











 

Treatment of tear trough:
It is recommented to treat baggy eyelid and tear trough  by fat transposition.  For cases presented with obvious tear trough, but no baggy eyelid, filler or fat injection into tear trough  is recommended. 

Below showed before (left) and after (right) pictures of a case underwent hyaluronic acid injetion into tear trough. 
  


Hyaluronic acid injection filled up the depression on tear trough.  But it should be emphasized that bulge of baggy eyelid existed after filler injection.

Below showed the case after hyaluronic acid injection. Marked area is baggy eyelid.  
 

For case with baggy eyelid and midcheek groove, baggy eyelid treatment following by fillers (such as hyaluroinic acid or fat injection) into midcheek groove is the best way to rejuvenate eyelid and cheek.  Below left is before picture.  Follwowing by picture after baggy eyelid surgery (fat transposition, internal incision).  Marking on third picture is the location of midcheek groove.  Last picture is the result after fat injection.  Cheek is fuller than before.



From the left picture to the right one: Before -> After baggy eyelid surgery -> Location of fat injection -> After fat injection


Four-lid blepharoplasty:
If problems of upper and lower eyelids coexist, blepharoplasty on four lids can be done at the same time.  Problems of four eyelids can be corrected in one recovery time.  Below case presented with sagging upper eyelid and baggy eyelid.  After four-lid blepharoplasty, she looks at least ten years younger than before surgery.  Right picture was taken on 8 months after surgery.


 

Below case is similar with above case.  After four-lid blepharoplasty, she looks prettier and younger than before.  Right is picture taken on 2 years after surgery.


 

Below case presented with sunken upper eyelid and baggy eyelid.  Fat block was put into upper eyelid to correct sunken problem.  In the same time baggy eyelid was corrected.  She is satisfied with the result.  Right picture was taken on 6 months after.


 

Eyes of below cases are prominent.  She also presented with multiple upper eyelid folds and baggy eyelids.  She underwent four lid blepharoplasty.  Right picture is taken on 8 months after surgery.


 

Below case presented with puffy eyelid, sagging eyelid and baggy eyelid.  Right is the picture on 2.5 years after excision of upper eyelid fat, excision of sagging upper eyelid and baggy eyelid surgery.  She is satisfied with the result.


Below case was 23 years old, presented with puffy eyelid and baggy eyelid.  She underwent four lid blepharoplasty.  Operation procedure included incision double eyelid operation with fat removal and baggy eyelid operation.  Right is taken on 4 months after surgery.  Eyes look more spiritual than before. 

  • If problems of upper and lower eyelids coexist, blepharoplasty on four lids can be done at the same time. Problems of four eyelids can be corrected in one recovery time.  Below case presented with sagging upper eyelid and baggy eyelid.  After four-lid blepharoplasty, she looks at least ten years younger than before surgery.  Right picture was taken on 8 months after surgery.


     

    Below case is similar with above case.  After four-lid blepharoplasty, she looks prettier and younger than before.  Right is picture taken on 2 years after surgery.


     

    Below case presented with sunken upper eyelid and baggy eyelid.  Fat block was put into upper eyelid to correct sunken problem.  In the same time baggy eyelid was corrected.  She is satisfied with the result.  Right picture was taken on 6 months after.


     

    Eyes of below cases are prominent.  She also presented with multiple upper eyelid folds and baggy eyelids.  She underwent four lid blepharoplasty.  Right picture is taken on 8 months after surgery.


     

    Below case presented with puffy eyelid, sagging eyelid and baggy eyelid.  Right is the picture on 2.5 years after excision of upper eyelid fat, excision of sagging upper eyelid and baggy eyelid surgery.  She is satisfied with the result.


    Below case was 23 years old, presented with puffy eyelid and baggy eyelid.  She underwent four lid blepharoplasty.  Operation procedure included incision double eyelid operation with fat removal and baggy eyelid operation.  Right is taken on 4 months after surgery.  Eyes look more spiritual than before. 

  • Sunken eyelid
    Due to atrophy of orbital fat, sunken eyelid is a sign of aging.  Sunken eyelid is presented with multiple folds, shallow fold and prominent bony structure around eyeballs.  Sunken eyelid can be found in some young women because of congenital reason. They look older than they really are.

    The ways to correct sunken eyelid are:
    1. Single eyelid fold or asymmetric fold with sunken eyelid can be corrected by incision double eyelid operation and inserting with fat block (usually from axilla).  Just like the case presented below. Right is the after picture after incision double eyelid operation and axilla fat block insertion.


     

    Below case underwent upper eyelid operation in another clinic.  Sunken eyelid is noted on her right eye.  Below right is result on one year and 8 months after upper blepharoplasty with axilla fat block insertion.


    Below show some cases after incision double eyelid operation concomitant with fat block insertion.

    2. Injecting fat into the sunken upper eyelid.  It is suitable for patients with double eyelid fold that does not have to be changed.  Fat is usually taken from thigh.  A tiny wound is made and fat is injected into upper eyelid.  Below case is a case with sunken eyelids, especially on left eye.  Below right is a picture on one year after fat injection.


    The other cause of sunken eyelid is blepharoptosis.  Blepharoptosis (abbreviated as ptosis) will be introduced in the following article.  In this situation, correction of ptosis will correct sunken eyelid.  

    Below picture is a case presented with sunken eyelid and ptosis.  Below right is the result after levator surgery.  Adding fat in such a case will aggravate ptosis (sleepy eye looking), because it will be more difficult to open eye after adding weight on eyelid, although the procedure improves sunken condition.


    Below left picture showed the before picture.  She was presented with sunken and sleepy eyes.  Below right showed the after picture after ptosis correction with internal approach (described in later section). T he ptosis and sunken improved after surgery.

If you live abroad, you may send your questions and pictures (such as eyes, etc) to mail@LRclinic.com.tw .
We will reply you as soon as possible.