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This is Dr. Nakao from Nakao Plastic Surgery.

Today, I would like to write about eye bag removal surgeries.

 

This is a female patients in her 50s.

Here an approach was made from the skin and the excess skin due to aging was removed.
Her orbital fat was moved to the hollowness inside the eye called the "tear trough".

The are four main methods for eye bags removal :

(1) Surgery to reduce dark circles by removing fat from the conjunctiva or "transconjunctival fat removal"

(2) Surgery to remove the orbital fat and orbital septum from the bone and pull them into the tear trough ligament which is causing the dark hollowness.

(3) Method (2) approach with removal of excess lower eyelid skin also due to aging 

(4) Method (3) approach along with a combination of a mid facelift to pull up the fat of the cheeks that have sagged due to aging

In the case of the picture, we used method (4).

The inner side (nasal side) is often solved by replacing the tear trough ligament by pulling in the orbital fat.

However, the outer dark circles are often caused by sagging of the orbital fat due to aging and also the sagging of the cheeks which causes the bump.

Even if the outer orbital fat is repositioned, if the sagging of the cheeks remain, the dark circles may appear after the swelling subsides.

So in middle-aged and older patients, it is often important to add a midface lifting procedure too.

In our clinic, we mainly combine Methods (2), (3) and (4) together with fat grafting.