Eye bags and droopy lids: Why they happen and treatments available

When you have had one too many late nights and inadequate sleep, it often shows up first around your eyes. And when combined with frequent eye rubbing, which can cause inflammation, the delicate skin in this area becomes stretched.

Over time, this can lead to bulging eye bags and

droopy, heavy eyelids

, leaving you looking even more tired. Beyond appearance, they may also affect your vision, leading to eye strain and fatigue, says Dr Adrian Ooi, consultant plastic surgeon and medical director at

Polaris Plastic & Reconstructive Surgery

.

Explains Dr Ooi: “Eye bags can be hereditary or a combination of various factors, such as loose muscle, skin and ligaments around the eye, orbital fat or an ageing bony facial structure.

“The lower eyelid skin is among some of the thinnest on the body and shows swelling and blood vessels more clearly than other areas. As we age, the ligament that supports the fat around the eye can sag, leading to a hammock-like eye bag.”

Droopy eyelids develop when collagen and elastic fibres in the skin around the eyes weaken with age. In some cases, a condition known as ptosis occurs where the muscle responsible for lifting the eyelid becomes loose over time as we age. This condition can also be present from birth.

Dr Pek Chong Han, consultant plastic surgeon at Polaris Plastic & Reconstructive Surgery adds: “Droopy eyelids can interfere with vision, causing forehead strain, headaches and, in some cases, accidents when the upper field of view is blocked”.

Treatments for eye bags

One procedure offered at Polaris for patients with stubborn eye bags is transconjunctival lower blepharoplasty, or

scarless eye bag remova

l

, which is done under local anaesthesia.

During the procedure, a small incision is made inside the lower membrane of the eyelid. Excess fat is then removed from there, and the ligament is released to reduce the “hammock-like” appearance below the eye. Fat can also be repositioned to help create a smoother and fuller cheek contour.

Care is taken not to remove too much fat to avoid future hollowing of the lower eyelids due to age.

Dr Pek Wan Sze, consultant plastic surgeon at Polaris Plastic & Reconstructive Surgery, says: “There is no external scarring and downtime is often a week or less; the lower eyelid wound is usually sutured closed. The most swelling happens during the first two days, and during that time, there may be some viscous discharge from the incisions.

“Generally, after that, the swelling improves, and by the end of the first week, there is almost no bruising. In the majority of cases, two weeks after the procedure, almost 90 per cent of the swelling is gone and there’s hardly any sign of the surgery.”

Aftercare typically consists of eyedrops, antibiotics, and cold and warm compresses to help with post-procedural swelling. Patients are also advised not to exercise for a week.

According to Dr Pek Chong Han, while the ligament and fat component is usually dealt with on a long-term basis, ageing in the skin and bone can still occur, thus leading to some minor, less obvious eye bag changes with time.

“It can be a one-off treatment, provided the patient continues to take care of their general health and skin. Additional treatments can be administered to help with skin tightening,” he adds.

One such complementary skin tightening treatment that Polaris offers is

Morpheus8

, which combines microneedling with radiofrequency energy to stimulate collagen production and tighten skin. It can also help to improve mild-to-moderate skin issues such as fine lines and wrinkles, notes Dr Ooi.

Patients will need to return for an assessment at the one-week and three-month marks. Beyond this, they can come back any time if they have issues, which Dr Ooi says is rare.

While many patients with eye bags are suitable for scarless eye bag surgery, Dr Ooi says the ideal patient is one whose eye bags are made up mainly of fat without too much excess skin.

Those with pre-existing medical problems affecting the eye bags, who have undergone previous open surgery to the lower eyelid, or who have poor muscle tone in this area may not be suitable for this procedure, he notes.

Patients above 60 years old and those with looser skin may want to consider a subciliary lower blepharoplasty instead, where an inconspicuous incision is made under the lower eyelashes to address the fat and ligamentous structures, as well as excise excess skin, says Dr Ooi.

He explains: “We assess individuals and tailor for them a procedure that will best suit them.”

Fixing droopy eyelids

When it comes to addressing droopy eyelids, Polaris offers upper blepharoplasty, a procedure that removes excess skin from the upper eyelids, and repositions the underlying tissues to create a more refreshed appearance, as well as tighten loosened muscles. The incisions are hidden within the natural eyelid crease to ensure minimal visible scarring.

The plastic surgery clinic also performs browlifts, which elevate and reposition the eyebrows to create a more youthful appearance, and

facelifts

– both help to further lift the droopy eyelids.

Explains Dr Pek Wan Sze: “Browlifts and facelifts can be done using short, or even hidden, incisions within the hairline to hide scars. The latter can be done with the aid of an endoscopic camera, usually under sedation or general anaesthesia.”

Facelifts at Polaris focus on the superficial musculo-aponeurotic system – a firm, natural tissue layer that supports the facial muscles – to create more lasting and natural-looking results.

The scars are inconspicuous, and the initial swelling from a facelift lasts for about two weeks, says Dr Pek Wan Sze.

“In addition, by taking care of your skin and performing minimally invasive aesthetic treatments regularly, you can help to prolong the effect of a facelift.

“Ultimately, the goal is to help patients feel and look more refreshed,” she adds.

Find out more about

Polaris Plastic & Reconstructive Surgery.