What is the difference between surgical and non-surgical permanent eye bag removal? (photo)

In the first instance, the term permanent removal is a misnomer as it can recur in both procedures, although it is well accepted that the surgical treatment gives results that last much longer, especially when done in an early stage/age.

Differences between surgical and non-surgical procedures

To understand the differences, let me first explain what constitutes an eye bag. To put it simply, the bulge in the eye bag is the result of herniated fat in the infraorbital region as well as a loss of elasticity and stretching of the skin in this region. This results in a bag-like appearance. The appearance can be made worse by a tear trough depression.

Therefore any procedure that aims to remove or treat the eye bag must involve removal of the herniated fat and tightening of the excess skin.

In surgical removal, it is usually scarless as the approach to remove the fat is trans-conjunctival. Any excess skin will then have to be removed through surgical excision and pulled up and held in place by stitches. Repositioning of the fat pads can help to reduce the tear trough depression and create a better outcome. The fat that is removed is permanent and does not recur, but if too much fat is removed, there have been instances where patients develop a hollowing of the undereye area later in life.

In contrast, non-surgical methods can range from using fillers to fill up the tear trough depression to camouflage the eye bags. However, this is only suitable for mild to early moderate eye bags.
Attempts to reduce or remove the herniated fat can be by means of microneedle radio frequency (RF), like Agnes RF, or by means of an interstitial fibre optic laser, like the Accusculpt laser (NILER).

Tightening of the excess skin in this area can be performed by energy-based devices like RF or HIFU although threads have also been used to improve the appearance of eye bags.

From this description of non-surgical techniques, it is quite obvious that non-surgical techniques offer a less permanent solution and in cases where the eye bags are severed in nature, they may not be a good option.

Looking at the picture, there are a few issues in the lower eyelids that need to be addressed in order to completely rejuvenate the lower eyelid:

• the bulging eyebag
• the deep tear troughs and lid-cheek junction lines
• mid face flattening
• and skin excess.

The extent of correction desired would impact on a few things:

• recovery time,
• scarless vs non-scarless approach and
• the "permanence" of the procedure.

It is important before choosing any corrective procedure to realise that the lower eyelids and hence the eyebags are dynamic structures and hence, doing something to correct the abnormality, such as a camouflaging procedure, may result in it looking good at rest or in a photo, but may not look as good when one is smiling or talking.

In my mind, surgical correction is the gold standard in treatment of moderate to severe eyebags with all the other issues illustrated in the photo in order to achieve a good dynamic result. Not only is the eyebag removed, but volume is added to the flat mid-cheek via a fat graft and excess skin removed and the mid face lifted via a mid-cheek lift procedure.

This also addresses the tear troughs and lid cheek junction lines. This produces a long-lasting result and without fear of eyebag recurrence; what recurs many years later is skin laxity and flattening of the mid cheek which gives the appearance of but is not an eyebag.

The difference, thus, with non-surgical treatment is how long the treatment will last and the extent of correction. Although there is a longer recovery time, what one obtains in exchange is a far longer period of rejuvenation.

In the first instance, the term permanent removal is a misnomer as it can recur in both procedures, although it is well accepted that the surgical treatment gives results that last much longer, especially when done in an early stage/age.

Differences between surgical and non-surgical procedures

To understand the differences, let me first explain what constitutes an eye bag. To put it simply, the bulge in the eye bag is the result of herniated fat in the infraorbital region as well as a loss of elasticity and stretching of the skin in this region. This results in a bag-like appearance. The appearance can be made worse by a tear trough depression.

Therefore any procedure that aims to remove or treat the eye bag must involve removal of the herniated fat and tightening of the excess skin.

In surgical removal, it is usually scarless as the approach to remove the fat is trans-conjunctival. Any excess skin will then have to be removed through surgical excision and pulled up and held in place by stitches. Repositioning of the fat pads can help to reduce the tear trough depression and create a better outcome. The fat that is removed is permanent and does not recur, but if too much fat is removed, there have been instances where patients develop a hollowing of the undereye area later in life.

In contrast, non-surgical methods can range from using fillers to fill up the tear trough depression to camouflage the eye bags. However, this is only suitable for mild to early moderate eye bags.
Attempts to reduce or remove the herniated fat can be by means of microneedle radio frequency (RF), like Agnes RF, or by means of an interstitial fibre optic laser, like the Accusculpt laser (NILER).

Tightening of the excess skin in this area can be performed by energy-based devices like RF or HIFU although threads have also been used to improve the appearance of eye bags.

From this description of non-surgical techniques, it is quite obvious that non-surgical techniques offer a less permanent solution and in cases where the eye bags are severed in nature, they may not be a good option.