“Doctor…I want to get rid of the bags under my eyes.” This is a common statement that I hear from new patients on an almost daily basis. In order to determine how to fix these “bags” we must first discover what actually causes them. Are they really bags?

The “bags” under the eyes are commonly caused by protrusion of fat from within the eyelids. This is fat that we all have for our entire lives. As we age, two major things happen to cause the lower eyelid fat to protrude: 1) The ligament that holds this fat within our eyelids actually weakens and 2) We lose volume (fat/bone/muscle) from around our eyes and cheeks.

Traditional surgery for lower eyelids often involves cutting out or removing the fat from the lower eyelid. However, I just told you that there were two main reasons for why those bags form. Neither of those reasons mention that our eyelids got fatter! The unfortunate consequence of removing fat from the lower eyelid is that in some cases, too much fat is removed, and the eyelid can actually appear to be hollow.

In most cases, instead of removing the fat, I reposition or place the fat back into the lower eyelid, where it came from. The best analogy is that of treating the fat like a hernia. It herniated out so we reduce it back into the eyelid. Only minimal fat is removed if any at all.

The next step is to fill in the volume that was lost over the years. This is done using the fat from your own body, called fat grafting. The fat is distilled/purified and then injected in very small amounts back around your eyes and cheeks. This is a long lasting/permanent fix to the lower eyelids.

Treating the “problem” will lead to the most natural looking results. I avoid the “surgical look” by following this principle. In the patient above, I treated her lower eyelids with the above mentioned procedures. She also had laser to reduce the wrinkling under her eyes and the crows feet. She is several months after surgery and notice how she looks like a markedly younger woman in the after picture.

For more information you can visit our blepharoplasty page and our fat grafting web page.

Fat grafting is a remarkable procedure performed to rejuvenate the face. As we age, we lose volume in the form of muscle, bone and fat from the face. The distribution of this fat loss will vary from person to person. The art of the facial plastic surgeon comes in when deciding where and how to place the fat.

Without question fat grafting is becoming exceedingly more popular. The effects of fat grafting are seen immediately and for years after the procedure. Since fat has a very abundant supply of stem cells within it, some people are calling the fat grafting procedure a stem cell face lift. This might make sense considering that we are injecting stem cells into the face along with the fat, however until I see definitive evidence that the stem cells play any roll in this, I will not tout it in that fashion. What I will say is that fat grafting works well, very well. As the word is getting out about this no incision procedure, more and more people are turning to it.

That being said, the most common question I get is…”How long does it last?” Fat grafting is a permanent procedure. Live fat cells are removed from the body, purified in my lab, and the transferred to the face (all at the same time). The key is making sure that the fat cells survive the sometimes traumatic process of moving it around. Harvesting, processing, and finally injecting the fat in the proper manner will ensure the longevity of this procedure. So bottom line is that the technique is crucial to the outcome and longevity of the procedure, and you must choose a surgeon very experienced in fat grafting to get the best results.

The photo above is of a patient of mine who is 1 year and 2 months after full face fat grafting. The area I want you to pay attention to is that of her cheeks. Although the entire face was injected, we will use the cheeks to demonstrate that after 14 months the cheeks are still full, and even fuller then they were at 2 months. At this point there is no question that the fat has taken and is now a part of her face.

It has been said that the eyes are the window to the soul. This speaks loudly, as the goal of any facial rejuvenation procedure is to restore attention back towards the eyes. What happens when that window is missing its drapes!

We often see patients that come in and have had prior blepharoplasty or eyelid surgery, where too much fat or skin has been removed. This defeats the purpose of cosmetic surgery as it does not make you look younger. In fact it makes you look older and un-natural.

A youthful eyelid is almost always associated with fullness around the eyes. Just take a look at any current fashion magazine. Take a look at some of the famous actresses and models today. All of them, almost invariably, have fullness to their eyelids.

That being said, preservation of this fullness must be maintained whenever performing eyelid rejuvenation and blepharoplasty. This means removing just the right amount of skin from the upper eyelid, and in most cases NEVER removing fat from the lower eyelid. For this reason, I perform a fat repositioning lower eyelid blepharoplasty that moves the protruding fat downwards instead of removing it, in order to prevent that hollowed out look. This is a story for another day, but you can read more here.

So what happens if too much skin, fat, etc. has been removed? This can be a difficult problem to treat. It is restorative plastic surgery. The case below is a woman who had no extra skin or fat in her eyelids (from prior surgery), yet she looks older purely because her eyes are too hollow. Since are minds have a harder time thinking in terms of addition (adding volume), I will show you these before and after fat grafting photos to give you a better idea. Take a look at how fat grafting her periorbital region (upper and lower eyes) has given her back years of youth and restored an attractive,youthful eyelid:

One of the most important concepts in understanding facial aging is the idea of deflation. As we age, unlike in the rest of our bodies, the face loses its fullness/volume.  This exposes the underlying bone, allows the skin to sag, and contributes to an aged appearance.

Facial volume is often overlooked when thinking about rejuvenating an aged appearance. A recent research study examined the appearance of identical twins throughout life. The study revealed that the “heavier” twin appeared more youthful then their “skinnier” counterpart. To reiterate: the identical twin, who had more facial fullness, appeared younger then his or her twin, who had a less full appearing face.

The conclusion from this study is not to go out and gain weight so you can look younger. It simply illustrates the importance of volume in facial rejuvenation. This is something which I have been preaching for years now. We see the loss of facial volume begin in our 20′s and its effects are noticed by a change in our appearance as early as in our 30′s.

When I speak of facial volume in this regard, it is not about filling in lines and wrinkles, it is a matter of restoring lost facial proportions caused by volume loss- filling in the areas that have lost volume. This is an art in and of itself that restores your youthful look in a very natural appearing way.

Visit our fat grafting page for more information on this procedure or our facial filler page.