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. 








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


  • 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. 

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