Eye Bag Removal
What causes eye bags?
Patients frequently consult aesthetic surgeons for lower eyelid problems such as eye bags, circles under the eye and wrinkles around the eye. Why are eye bags a common concern? Because they make a person look tired, weary, aged or unhealthy.
Eye bags may be caused by:
- Genetics in which the bone structure may not adequately support the overlying tissues allowing the surrounding fat to bulge, or the fat pockets are excessive in size
- Ageing in which the laxity of the overlying skin, supporting superficial musculoaponeurotic system (SMAS) and facial ligaments allow fat compartments to sag forming bulges and folds
- Excess fat pockets
to treat eye bags safely and effectively
Fractional Energy Devices for Eye bag Removal
Fractional Infrared Lasers
Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. It can be further subdivided into ablative and non-ablative. Ablative fractional lasers have longer wavelengths (e.g. CO2 10600nm) and lead to full thickness destruction of skin, whereas non-ablative fractional lasers have shorter wavelengths (e.g. Erbium Glass 1550nm) and leave an intact skin surface. CO2 has greater efficacy compared with Erbium Glass but longer recovery time and a higher risk of complications.
Fractional Infrared Lasers have a good body of research evidence demonstrating safety and efficacy.
Fractional Picosecond Laser - Discovery Pico Plus
Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. The highly concentrated energy produces laser-induced optical breakdown (LIOB) stimulating collagen production with almost no downtime.
Fractional Bipolar Radiofrequency for Eye bag Removal
Eye bag removal with Fractional Radiofrequency Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of ablative lasers. Hence Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.
Fractional Microneedle Radiofrequency
Skin remodelling for eye bag removal requires heat delivery to the deep part of the skin. However, in most machine-based treatments for scarring such as lasers, much of the energy is dissipated at the skin surface and little reaches the deep layers. Fractional microneedle radiofrequency overcomes this using insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety.
Subdermal laser or radiofrequency for Eye bag Removal
A tiny probe inserted under the skin is used to conduct laser energy or radiofrequency energy that is absorbed by the skin and surrounding tissues, stimulating collagen contraction and production to tighten loose skin, reshaping bulging or loose tissue.
High-Intensity Focused Ultrasound
High-intensity ultrasound energy is focused precisely on the targeted fat layer, creating a rapid rise in local temperature at the targeted area without harming surrounding skin, tissue or organs. HIFU relies on the fact that, above a threshold of 56 degree C (for > 1 second), irreversible cell death occurs. The heat produces a dual tissue response within the treatment area - permanent destruction of targeted fat cells and contraction of surrounding collagen that helps improve tissue laxity. The body naturally removes the destroyed fat from the treatment area, reducing the size of a fat deposit.
Injection lipolysis for Eye bag Removal
Belkyra / Kybella is a synthetic form of deoxycholic acid, a substance that is otherwise naturally produced by the body and that helps absorb fat. Deoxycholic acid has the potential to kill fat cells. The body gradually metabolizes the dead cells during the weeks after treatment.
Injectable dermal fillers are hydrogels that can be implanted to enhance the shape and contour of the nose. They can be classified into temporary, semi-permanent and permanent fillers. Temporary fillers are most popular and can be classified into 2 broad groups:
- mainly volume replacement - most commonly composed of hyaluronic acid, a naturally occurring glycosaminoglycan polysaccharide which draws and binds water to itself and the surrounding skin. Other examples include agarose or collagen
- collagen stimulating - contain materials such as calcium hydroxyapatite, polycaprolactone that cause the body to produce collagen
Fillers have different structural properties such as cross-linking that manifest in their rheological properties such as viscosity, cohesivity, hardness and resistance to deformity. Hard, cohesive and viscous fillers are preferable for structural support as they keep their shape well. Soft or medium viscosity fillers can also be used for certain softer areas such as the undereyes.
1Aesthetics's View on Eye bag Removal
dr wan's perspective
Eye bags may be present even in a young and otherwise slim face. Often, however, they grow more prevalent with age.
Essentially they can be viewed as collections of excess orbital fat in a loose skin pocket comprising a facial compartment which may have deficient underlying cheek bone support. In the past, patients simply underwent lower blepharoplasty to remove eyelid skin and fat. However, for many patients this gave suboptimal results or a hollow appearance. This is because eye bags removal often result from a combination of anatomical factors such as:
- Tear trough depression
- Orbital fat prolapse
- Loss of skin elasticity
- Accumulation of fluid within the eyelid
- Orbicularis muscle prominence
- Triangular malar mound
These factors contribute to differing extents in different individuals hence it is necessary to analyze each patient individually with 3D imaging and especially feeling and measuring the area to find out the relative contribution of each factor and address each factor appropriately:
- Filler in the cheek and tear trough to shore up bony support, reducing the protrusion of the eyebag
- HIFU to reduce the excess protruding orbital fat
- Fractional energy devices tighten the thin skin pocket in the area while subdermal laser / radiofrequency can have more of a direct effect on the deeper supporting structures