Lower eyelid lift (bags under the eyes)

Lower eyelid lift? Remove bags under the eyes? Questions for PD Dr. Mathias Tremp

The lower eyelids are very important aesthetically. Accordingly, discolored eye bags, tear troughs or excess skin can give a tired impression. The excess skin or dark eye bags can be hereditary, age-related or due to a certain lifestyle (e.g. smoking, stress or lack of sleep) and are caused by a progressive weakening of the connective tissue.

The dark circles under the eyes are the result of a lack of collagen, which causes the blood vessels to shine through under the skin and creates dark circles under the eyes. A lower eyelid lift can give you a fresh, alert and youthful impression. The procedure is often combined with additional procedures to rejuvenate the eye area.

Lower eyelid lift: What techniques are there?

The incision for a lower eyelid lift can be made either from the outside in the area of the lower eyelid edge with appropriate skin and fatty tissue removal or in the area of the conjunctiva.

The advantage of an internal incision in the area of the conjunctiva is an invisible scar. But even the scar from an external incision will hardly be visible over time. In the case of pronounced “bags under the eyes” (actually fat pads), these can be redistributed by an internal incision and thus the tear trough can be corrected, as described in the graphic below. The so-called pull-through sutures are removed after 3 days.

In case of severe sagging skin of the lower eyelid

For patients with severe sagging skin on the lower eyelid, a so-called canthopexy is necessary, ie the outer edge of the eyelid is stabilized on the periosteum of the eye socket (so-called cat eye lift). During a detailed consultation, the method that is suitable for the patient is determined individually.

How is the operation performed?

The operation can be performed on an outpatient or inpatient basis. The procedure can be carried out under local anesthesia, twilight sleep or general anesthesia and is determined individually during the consultation depending on the patient’s wishes and the extent of the operation.

What do I need to consider before the operation?

If you smoke, you must abstain from nicotine for two weeks before and after the operation. This improves the oxygen supply to the skin, accelerates wound healing and helps the scar heal better. You should also avoid taking blood-thinning painkillers such as aspirin or Brufen, as well as high doses of vitamin E, for around 10 days before the operation. Therapeutic blood thinners such as Marcoumar®, Xarelto® or Eliquis® must be stopped on an individual basis and after consultation with your doctor. On the day of the operation, patients must avoid cosmetics and creams.

Can a lower eyelid lift be combined with other surgeries and treatments?

A lower eyelid lift can be performed with a simultaneous mid-face lift. A lower eyelid lift is often combined with a fat transfer treatment (micro or nano fat).

The advantage of micro and nano fat treatment is that, in addition to restoring facial volume, the skin pigments in dark circles under the eyes are chemically broken down by so-called fat stem cells. In addition, lower eyelid surgery can be combined with other facial procedures (e.g. nose correction, upper eyelid surgery, face and neck surgery, eyebrow surgery).

Are there alternative treatment methods for lower eyelid rejuvenation?

If there is a small amount of excess skin, lower eyelid rejuvenation can be performed using a radio frequency microneedling treatment. Other alternative options for non-surgical eyelid rejuvenation are laser treatments, chemical peels, mesotherapy (hyaluronic acid, vitamins, amino acids, minerals and many other active ingredients, nano fat treatment or autologous blood treatment (so-called Platelet Rich Plasma = PRP).

The autologous blood treatment uses a growth cocktail (so-called growth factors/exosomes) of the blood platelets to rejuvenate the eye area by smoothing out wrinkles and thickening the skin by means of collagen stimulation (biostimulation). This makes dark circles under the eyes less visible.

What are the risks of treatment?

As a rule, the risks of a lower eyelid lift are manageable and uncomplicated. Possible, rare complications include bruising, infections, bleeding after surgery or drooping lower eyelids due to scarring or excessive skin removal. Eye injuries are also very rare, but cannot be completely ruled out.

Is a lower eyelid lift painful?

The lower eyelid lift is not very painful. Paracetamol is usually sufficient for the first few days after the operation. In addition, the eyelids should be cooled regularly.

Is the result permanent?

The first result is visible immediately after the operation, the swelling and redness subsides after about 10 – 14 days. The final result will then be visible after about 6-12 weeks.

What should I pay attention to after the operation?

The eyelid must be cooled immediately after the operation. This will prevent any swelling or bruising. To further reduce swelling, the upper body should be elevated for the first few days and also at night. To supplement the swelling, Arnica can be taken for 7 days after the procedure.

The stitches are removed after 5 to 7 days. Then you are usually able to go out in public and you can also wear make-up. After that, I recommend regular scar care and sun protection SPF 50. If you wear contact lenses, you can wear them again without any problems after 2-3 weeks.

What does it cost?

Since the procedure is often an aesthetic treatment, health insurance companies usually do not cover the costs. An exact cost estimate can only be made after a personal consultation.