Internal blepharoplasty? External blepharoplasty? Which surgery is more suitable for me? [Plastic Surgery - Dr. Hsin-Yu Chen]
"My eye bags are so swollen! And a bit sagging too, what kind of eye bag surgery would be suitable for me?"
eye bagsThe appearance of eye bags is the most dreaded early sign of aging. No matter how much you try to conceal it, you can't hide the signs of aging and fatigue. Combined with sunken tear troughs and sagging cheeks, it makes you look even more haggard, heavy, and old. However, eye bags are not exclusive to middle-aged and elderly people. Due to congenital structural issues or changes in modern eye habits, many people suffer from eye bags at a young age.
Why do eye bags make people look so old? We can see that children's eye area is smooth and plump, without shadows under light, giving them a youthful and lively appearance. However, once fine lines, eye bags, and tear troughs appear under the eyes, the once smooth, silky skin becomes uneven, creating complex shadows under natural light. Visually, this makes a person look older and tired. Furthermore, the skin around the eyes is delicate and the muscles are expressive, making it difficult to conceal these imperfections with layers of makeup. A single movement immediately reveals these flaws, having the opposite effect. The stark contrast between drooping, protruding eye bags and sunken tear troughs is impossible to smooth out with any method.
First, let's talk about the three-dimensional structure around the eyes. The skin of the eyelids is very thin, with the orbicularis oculi muscle tightly attached beneath it. Further inwards lies the entire orbital septum, extending from the orbital periosteum and covering the entire orbit, forming a retaining wall structure. Inside the orbit, fat forms a cushioning pad for the eyeball. Normally, the fat is confined within the orbit by the orbital septum, but some people are born with more orbital fat, resulting in bulging eye bags at a young age. Next, let's look at the junction of the eyelid and cheek. Here, the skin thickens, and near the nose is the location of the tear trough ligament. It attaches to the edge of the orbital bone, passes through the orbicularis oculi muscle, and extends into the dermis of the skin.
The face has many similar ligamentous structures responsible for maintaining the correct position of the skin on the facial bones. Normally, if the orbital fat and the soft tissue of the mid-face are in balance, the surface from the eyelid to the cheek will be flat and full. However, if the orbital bones are sunken, or if the soft tissue of the cheek is not supported enough and sags, the tear trough ligaments will pull on the surface skin to form a depression, which will visually create an aging shadow and a sense of boundary.
Periorbital aging from the surface to the depths
Aging around the eyes affects everything from the surface skin to the deeper tissues:
1. The skin of the eyelids and the orbicularis oculi muscle become loose, and with the loss of collagen, fine lines appear around the eyes, and the skin loses its elasticity.
Second, the orbital septum will also loosen and lose its original function as a retaining wall. The fat in the orbit will then sag and bulge forward and downward due to gravity, forming eye bags.
Third, as we age, the facial bones at the attachment point of the tear trough ligament atrophy inward. In addition, the loss of collagen and fat in the face leads to insufficient support from deep soft tissues, causing the skin to gradually sag. The tear trough ligament then pulls the skin inward, forming a sunken tear trough.
Eyelid bag surgery: Improves sagging and strengthens soft tissue support
The purpose of blepharoplasty (eyelid surgery) is to remove excess fat, repair aging and sagging tissue, and strengthen the support under the eyes. However, because the causes of eyelid bags vary from person to person and the tissue condition is different, the doctor will choose the appropriate treatment method based on the individual's situation. The surgery can be broadly categorized into internal and external incision procedures.
Eyelid surgery - internal eyelid surgery
(Suitable for mildly loose skin, but requires treatment of fat deposits and tear troughs.)
Excess fat is removed through a conjunctival incision, and the loose orbital septum is tightened. The fat is then pushed back into its normal position within the orbit, thereby improving prominent eye bags. On the other hand, it is necessary to...Fill in tear troughsTissue lost in the depression.
Simple fat transfer, which involves repositioning fat removed from under-eye bags into the tear trough, usually results in insufficient fat and is less effective at smoothing out indentations caused by adhesions between the skin and underlying ligaments in the tear trough area. Therefore, it is recommended to undergo [further procedures].Multi-layer ligament release combined with autologous fat transplantationThe goal is to break the tear trough ligament's pull on the surface skin as much as possible, and then transplant fat from other parts of the body to replenish the tissue loss from the superficial to the deep layers, and to plump up the mid-face area adjacent to the lower eyelid.
Once we address the protruding under-eye bags and the sunken tear troughs, restoring smoothness and elasticity from the lower eyelids to the cheeks, the appearance will be brighter and more youthful. Generally, there is considerable swelling after autologous fat grafting surgery.Three monthsIt will gradually return to its natural state. Once the transplanted fat has survived stably, its weight will likely fluctuate with the individual's weight.
Eyelid surgery - Lateral eyelid surgery
(Suitable for patients with severe skin, muscle, and connective tissue laxity, requiring treatment of excess skin, eye bags, and tear troughs.)
The procedure involves making an incision along the lower lash line to treat excess skin laxity. If the mid-face sagging is severe, this can be performed simultaneously, depending on the situation.Mid-face liftIt suspends the collapsed tissue back into its normal position, restoring its firmness and fullness.
Why do the results of the same eye bag surgery vary from person to person?
Periocular agingThe causes are diverse, and the severity of aging varies from person to person, with different starting points, so the results will naturally differ. For patients with severe sagging, the overall tissue elasticity is usually poor, and using the same treatment method may not be able to eliminate the long-accumulated depressions, resulting in less favorable postoperative results compared to patients with mild sagging. Furthermore, the degree of tissue loss is often greater than imagined; if the mid-face is severely sunken, two or more autologous fat grafting sessions may be necessary to gradually restore fullness to the cheeks.
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Don't forget about skin.
Skin texture greatly affects the appearance around the eyes. For patients with poor skin texture, low elasticity, and many wrinkles, even after surgery, they often cannot escape the signs of aging. This is because the process of combating aging is like renovating an old house. Surgery can address the structural problems of aging, but even if the internal foundation is improved, without a corresponding exterior renovation, the appearance will still be somewhat lacking. Therefore, it is recommended to combine this with other skin treatments, such as radiofrequency or skin resurfacing, to promote collagen production in the superficial layers of the skin, restoring its smoothness and elasticity, truly achieving rejuvenation from deep within to the surface.
想要明亮有神大眼，如何打造漂亮的雙眼皮摺線？【整形外科-Dr. Hsin-Yu Chen】
