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​What causes eye bags?

Eye bags occur when fat tissue behind the lower eyelids bulge forward. This happens when the membrane in the eyelid, which holds the fat back, weakens with age, as shared by the Oculoplastic service at Singapore National Eye Centre (SNEC), a member of the SingHealth group.

Surgery removes eye bags by repositioning the protruding fat, and in some cases, by removing excess skin under the eyes. But doctors are conservative when removing excess skin to prevent the lower eyelid from turning out after surgery – which would expose the inner membrane along the lower edge of the eye.

"We have to judge carefully how much excess skin we can remove, without risking such complications. So, sometimes, there may still be fine lines under the eye after surgery," explained the department.

Surgeons also avoid the inferior oblique muscle hidden in the fat, as disturbing it can cause double vision. The muscle – located at the base of the eye – is responsible for the movement of the eye. Extra care is taken not to pull excessively on the fat as this can trigger haemorrhage behind the eye and cause visual loss. "This is very rare, but it has been reported in the past when the trend then was to remove as much fat as possible."

Surgery for eye bags

There are two different approaches to eye bag surgery.

  • Transconjunctival approach: A cut is made on the inner lower eyelid through which a bit of fat is removed. There is no scar, so healing is faster. It is suitable for patients in their late 30s to early 40s who have fairly elastic skin and mild bulging of fat. It is also ideal for young thyroid patients with increased fat volume around the eyes.
  • Subciliary subcutaneous approach: A cut is made below the lower lash line and the inner membrane is opened up. The sagging fat is repositioned. If the lower eyelid is lax, the muscle or tendon of the outer eye corner is tightened for improved support. It is suitable for patients with excess skin, which can be removed as well.

Click to next page to read about double eyelid surgery.

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