How do you fix eyelid bags?

The eyes are often one of the first areas of the face to show aging. Some of these changes are related to your lifestyle- if you are, perhaps, on call all the time and/or have young children who wake up screaming every night to have their blankets repositioned, it might end up showing in your eyes!

Four young kids = Eyelid bags

While stress and lack of sleep can contribute to eyelid bags, the main reason they become prominent is the anatomy of your lower eyelid. As we proceed from the outside in you pass through skin, then a layer of muscle that allows you to do this:

No, I don’t have a secret. I’m showing off my orbicularis oculi muscle.

Behind the muscle is a thin layer of connective tissue called the “orbital septum.” Don’t worry, there won’t be a quiz later. Behind the orbital septum is a bunch of fat. The fat is supposed to be there. It cushions your eye in case you get whacked in the face with something. The amount of fat doesn’t really change with weight gain or weight loss. It’s just there. Eyelid bags happen when that thin layer of connective tissue gets weaker. The weakness allows fat to bulge forward and -BOOM- you have eyelid bags.

While I can’t help you to get more sleep, I can fix your eyelid bags so it LOOKS like you’re better rested. There are a couple of techniques. The one we choose is based partially on what your eyelid bags need and partially on your goals.

Fillers can be a good option to camouflage smaller eyelid bags.



Two weeks after fillers


Fillers come in different thicknesses and have many uses on the face. I will typically use a thin product like Volbella® when I’m working on eyelid bags. The tissue in this region is thin and unforgiving, so thin products are preferred to minimize the risk of visible lumps. While this solution isn’t permanent, I have seen filler last for over a year when used in this way.

The filler is placed right along the orbital rim where the tissue is at its thinnest. This helps to smooth the transition between the eyelid bag and your cheek, camouflaging the bulge.

You may get a small, temporary bruise – for more on how to prevent bruises, check out this post from my blog archives. The effect is immediate, although it can take a few days to settle in.

If you want to remove your eyelid bags instead of just camouflaging them, we have a few options.

The least invasive option is a treatment called Pellevé. It uses radio frequency energy to stimulate collagen production in the deeper layers of your skin, tightening it and improving the appearance of the under eye tissue. It’s totally a non-invasive procedure performed in the office. The effects are immediate and continue to improve over several weeks. Here’s yours truly immediately after having a treatment.

Feeling cute. Might pick up the kids and make dinner because I’m a dad and that’s what I do. IDK.

If you want a more permanent solution to your eyelid bags, there are several surgical options. While I routinely do upper eyelid surgery in my office, you’d most likely want to have your lower eyelid bags removed in an operating room with some sedation. For younger patients with very elastic skin (think 30’s to early 40’s), we make an incision behind your eyelid (so no external scars!), find the connective tissue layer, and remove excess fat. If you wear contacts, you need to wear glasses for a couple of weeks following this procedure. It’s very safe, but you can imagine why you’d want to be put to sleep. This method only addresses excess fat, but not extra skin.


Before and after photos of eyelid bag removal with an external incision.

Most patients with eyelid bags need their excess skin addressed along with the fat. The way we do this is to make an incision right underneath the eyelashes. The skin and muscle are raised up and excess fat is removed. Next, the excess skin and muscle is laid down and trimmed to exactly fit the incision line.

Surgery for eyelid bags isn’t right for everyone.

If you have dry eyes, surgery can make them worse. If you have thyroid problems, you’ll want them under control before any discussion of eyelid surgery.

Whether you’re an exhausted parent or a 60-something executive who wants to look refreshed, we’d love to talk to you about your eyelids. Give us a call at 804-762-0080 today to book your consultation to learn which options are best for you!

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