Dr. Brooke R. Seckel
A no scar eyelid surgery to remove eye bags without a visible incision scar on the eyelid is now becoming more popular. The eyelid surgery procedure is done through the inside of the lower eyelid and using this new technique eye bags can be removed with no visible scar on the eyelid.
The traditional eyelid surgery to remove eye bags or puffy eyes uses an incision on the outside of the lower eyelid beneath the eye lashes and is called a Lower Eyelid Blepharoplasty. The lower eyelid Blepharoplasty leaves a visible scar on the outside of the eyelid below the eye lashes. The pink skin on the inside of the eyelid that you see when you pull the eyelid down is called the Conjunctiva. The no scar eyelid surgery uses an incision made on the inside of the eyelid through the conjunctiva thus the technique is called a Trans-conjunctival Blepharoplasty. As shown in the image below the Trans-conjunctival Blepharoplasty uses a small incision on the inside the lower eyelid to remove protruding fat which is causing the eye bags or puffy lower eyelids. Often a laser is used to make this tiny incision. Because the Trans-conjunctival Blepharoplasty incision is made on the inside the eyelid there is no visible scar on the outside of the eyelid. This means that people looking at your eyelids cannot tell that you have had lower eyelid surgery to remove eye bags.
Because the eyelid surgery without scars uses an incision on the inside of the eyelid the eyelid skin and supportive structures such as muscle and ligaments are not damaged. As a result support of the eyelid is maintained and the eyelid does not get weak and sag down during healing. Several advantages include:
• No visible eyelid scar–people cannot tell that you have had lower eyelid surgery to remove eye bags or puffy eyes.
• No change in eyelid shape–because no incision is made through the eyelid skin the supporting structures of the eyelid are maintained. This preserves the nice gentle upward slant of the lower eyelid. Traditional eyelid surgery with a visible outside scar on the eyelid can result in a downward pull of the eyelid.
• No stitches are used–thus you will not have to undergo removal of stitches.
Because traditional lower eyelid surgery involves an incision through the eyelid skin and muscle directly under the eyelashes several important structures can be injured during surgery. The eyelid muscle and the underlying membrane called the septum once injured by an incision can scar and contract over time resulting in a downward pull of the eyelid. This can cause more of the white eyeball to be visible beneath the Iris, the colored part of the eyeball. This can also create a sad eyed look, hound dog eyes or worse an Ectropion a serious condition that can harm the eye. If an Ectropion occurs the eye can be exposed to air and create serious eye complications including dry eye syndrome or worse. The disadvantages of the traditional eyelid incision include:
• Visible scar
• Downward pull of the eyelid with ectropion
• Change in eyelid shape
• Dry eye syndrome
The best candidates for eyelid surgery for eye bags without scars are younger patients without advanced aging of the eyelid. The best candidates for no scar eyelid surgery include:
• Patients with eye bags or puffy eyes with smooth tight lower eyelid skin
• Patients with good eyelid support who do not have eyelid sagging
• Patients without severe sun damage, wrinkles and loose eyelid skin
• Patients without extra folds of skin on the lower eyelid that wrinkle with smiling
Eyes before and after no scar eyelid surgery to remove eye bags
One limitation of the no scar eyelid surgery to remove eye bags is that no eyelid skin is removed. Thus patients who have an excess amount of loose skin will find that the loose eyelid skin may look looser after fat removal through the transconjunctival blepharoplasty approach. Patients who may need a traditional blepharoplasty with an external scar would include patients who have:
• Excess loose eyelid skin in addition to eye bags
• Patients who have lax lower eyelids–these patients will need an eyelid tightening procedure called a canthopexy.
• Patients with Festoons which are extra bags below the lower eyelid and on the cheek. These patients require special surgical procedures or fillers.
Although no scar eyelid surgery to remove eye bags is much more commonly performed today many plastic surgeons still use the incisional approach that causes a visible eyelid scar that shows beneath the eyelashes. Not all plastic surgeons are comfortable doing eyelid surgery with no scar. It is important to search for a plastic surgeon who is very experienced in eyelid surgery or oculoplastic surgery. You can obtain this information by searching on the Internet and specifically questioning the staff when you call the office for your appointment. The Smart Beauty Guide published by the American Society for Aesthetic Plastic Surgery is a good place to start your search.