Rethinking Eye Bags

Patients with eyebags with significant midcheek aging

Patients with eyebags and associated with midcheek aging : Rethinking eyebag surgery: Looking beyond the eyebags to achieving TRUE midcheek rejuvenation

Eyebags are one of the most common cosmetic concerns of patients presenting to the plastic surgeon. As the patients request for their eyebags to be removed, excision of the orbital fat pads that is responsible for the ‘bags’ has been the conventional wisdom for many years. While the fat excision or removal approach is still valuable and valid in selected patients, it may not be the best solution for many others presenting with the problem of ‘eyebags’. Here, I would like to discuss deeper concerns of patients presenting with eyebags, recent advances in the understanding of the anatomy of the aging midcheek (of which the eyebags is part of) and the elements needed to achieve optimal midcheek rejuvenation.

First, lets consider what the patients are really seeking beyond correction of the eyebags. While the eyebags are quite noticeable, when we look deeper, it is ‘tired look’ that has gradually replaced the ‘fresh’ look that the patients once possess in their youth that so burden the patients. One that makes them appear to lack vitality even though they maybe full of energy inside. This appearance can be attributed to the complex changes of the midcheek that occur with aging.

Therefore, at a deeper level, what patients presenting with eyebags is actually seeking is rejuvenation of the midcheek to give them a fresh and youthful look that was lost with aging. Importantly, the eyebag is but one aspect of the aging midcheek, addressing the eyebags alone is inherently limited by what it can achieve. Accordingly, all aspects of the aging midcheek need to be address to achieve the highest level rejuvenation. Lets now turn our attention to what we now know about the anatomy of the aging midcheek.

The aging midcheek comprises of several components. One this is the bulging of the orbital fat that is commonly known as eyebags. This is also perhaps the most noticeable change with aging. Equally significant however is that part of the cheek, immediately below the eyebag. The soft tissues here deflate and descend with aging. This is particularly profound in the inner aspect of the midcheek.

A further significant change is the retrusion or resorption of the midface skeleton. This contributes profoundly to the loss of soft tissue support of the aging midcheek. Finally the skin thinning and fixed wrinkling all contribute to the appearance of the aging midcheek.

In particular, deflation is an aspect of the aging midcheek that is increasingly recognized as an important contributory factor. One only has to observe the fullness in the midcheek that is so evident in youth to appreciate the importance of volume restoration in midcheek rejuvenation.

A recent anatomical advance is the understanding of the facial retaining ligaments of the midcheek. The retaining ligaments are discrete fibrous structures the bind the tissue layers together. It is because of its function that it manifest a surface grooves we see with aging. A prime example of this is the tear trough that we so commonly see below the eyebags. Precise release of these ligaments can effectively soften these grooves that we see, playing an integral part in rejuvenation of the midcheek.

Having this appreciation of factors that contribute to the tired look then, procedures to correct this aesthetic problem should be designed to address all these components of the aging midcheek.

Considering conventional eyebag surgery then, excision is often the prescribed solution for patients presenting with eyebags. While fat excision alone is effective in selected patients, namely patients with ‘true’ excess of the orbital fat, fat removal alone is inherently limited by what the procedure can achieve in patients with more advanced midcheek aging. Executed well, removal of the fat would eliminate the eyebags. However, quite often this does not produce the refreshed look that patients are seeking.

Talk On Midcheek Rejuvenation

Because of the significant deflation, loss of volume as well as the descent in tissue as explained, to achieve the refreshed look, these aspects have to be addressed. Accordingly, in rethinking our approach to the common complaint of eyebags, depending on the patients’ specific needs, the following may warrant consideration:

1. The eyebags: This may be removed in cases of true excess or more commonly, the fat may need to be preserved but REDISTRIBUTED to move it from area where it is not wanted to that part of the cheek where VOLUME is deficient.
2. For the descended cheek tissues, a CHEEK LIFT is needed to reposition the cheek mass into a more YOUTHFUL position
3. For patients with more significant loss of volume or deflation of the midcheek, these need to be restored. This can be achieved by either synthetic fillers (such as hyaluronic acids), cheek augmentation with implants or increasingly popular now with micro fat grafting.

In rethinking eyebags therefore, the following can be said

1. In patients with true orbital fat excess, the fat excision technique continue to be an effective approach in its correction
2. In patients with significant aging changes wanting to achieve the fresh and rejuvenated appearance, a more advanced approach incorporating fat redistribution, midcheek lift and midcheek augmentation with fat grafting is currently the most powerful technique available.

Please visit us for an in-depth discussion on your specific needs.