Many mistakenly believe eye bag removal is straightforward, stemming from misunderstanding its causes and manifestations. Relying solely on a single surgical approach often yields poor results, with some patients experiencing severe complications like incision scarring, uneven eyelids, eyelid-scleral separation, or even lower eyelid ectropion.Some patients experience prolonged post-operative discomfort, including dryness and tearing. Severe cases of ectropion may cause conjunctival hyperemia or even corneal ulcers, impairing vision. In recent years, through in-depth research by domestic and international scholars on the causes and types of eye bags, optimal surgical solutions have been developed for various types. Therefore, different treatment approaches should be adopted for different eye bag conditions: 1. Eye bags caused solely by thickened orbicularis oculi muscle.Due to genetic factors, lower eyelid bags appear at a young age. Their defining characteristic is a continuous, arc-shaped distribution near the lower eyelid margin, with no skin laxity. This type is most common in individuals aged 20-32. For cases involving solely thickened orbicularis oculi muscle, only muscle reduction is necessary; fat removal is not required.
2. Pure skin laxity type. This condition involves laxity of the lower eyelid and lateral canthus skin without orbital septum laxity, thus lacking protruding orbital fat. Fine wrinkles appear around the eyes, commonly seen in middle-aged individuals aged 33-45.For cases of isolated skin laxity, only excess skin needs to be removed without damaging other tissues such as the orbicularis oculi muscle or orbital fat. This avoids complications like orbital fat removal-induced depression or unnecessary issues such as retrobulbar hemorrhage leading to vision loss.
3. Mild to moderate lower eyelid bulging. This is primarily due to congenital overdevelopment of orbital fat, commonly seen in young to middle-aged adults aged 23-36.
For moderate to severe lower eyelid bulging, the conjunctival approach—removing excess orbital fat via an internal incision—is recommended. This method leverages the skin's natural elasticity to prevent laxity, eliminates external scarring, minimizes trauma, reduces swelling (sometimes eliminating it entirely), and enhances surgical safety.
4. Moderate to severe lower eyelid bulging accompanied by skin laxity.This primarily involves laxity of the skin, orbicularis oculi muscle, and orbital septum, causing gravitational prolapse of orbital fat. Severe cases may present with laxity of the lateral canthal ligament, tarsal eversion, and epibulbar prolapse, often accompanied by epiphora. This condition is most common in middle-aged and elderly individuals aged 45-68.
For cases with skin laxity and moderate to severe lower eyelid bulging, an incision along the eyelid margin is required to remove excess skin and prolapsed orbital fat, while simultaneously tightening the orbital septum and orbicularis oculi muscle.
5. Skin laxity accompanied by a depression between the lower eyelid margin and the infraorbital rim.This condition is also common among middle-aged and elderly individuals, characterized by skin laxity alongside atrophy of orbital fat and pre-tarsal fat. For cases with skin laxity and a depression between the lower eyelid margin and the infraorbital rim, lateral canthopexy is performed to correct lower eyelid ectropion. This approach is essential for achieving optimal cosmetic results.
It's important to note that eye bag surgery is not as straightforward as it may seem. Only through the accurate assessment of varying conditions by experienced surgeons at reputable plastic surgery hospitals can optimal cosmetic results be achieved while minimizing surgical complications. This seemingly minor procedure involves significant expertise.