Under Eye Bag Surgery & Lower Lid Filler Removal
If there’s one thing that makes a person look older and more tired than they really are, it’s under eye bags. These bags often become severe as we age, with fluid and fatty deposits collecting underneath the eyes and causing puffiness. Known as malar bags or “festoons,” these depressions and bulges can change a person’s resting expression, making them look chronically tired and worn out.
Beautiful models on TV offer hope in a jar: lotions and potions claiming to fix under eye bags. But for severe eye bags, topical treatments can’t offer much help. For patients who have festoons, sometimes called “bags on bags” only professional treatment can make a difference. Dr. Allan Wulc, a board-certified plastic surgeon at W Cosmetic Surgery, is a pioneer in the treatment of festoons. He offers patients in Philadelphia an effective and innovative treatment that combines microdroplet liposculpture with dual erbium laser resurfacing.
Under Eye Bag Surgery Results
Not every patient’s journey to eyelid rejuvenation is the same. Together, we can help you discover the best treatment options to restore youth and beauty to your eyes. Some typical festoon treatment results are featured in our gallery.
*Each patient is unique and individual results may vary.
Why Do We Get Under Eye Bags?
Under eye bags and festoons are very common in older patients. Due to the location of several key facial structures, the eye area is prone to developing distinctive bags as a person ages. Young people often experience intermittent eye puffiness when they don’t get enough sleep or they retain water, but bags on bags only become permanent when the malar pockets develop due to aging and sun exposure. With age, the muscles in the eye area begin to weaken and the facial skin often becomes thin and delicate due to collagen loss. This allows the fat pads beneath the eyes to shift with gravity and bulge forward.
Benefits of Under Eye Bag Surgery
Many patients are extremely self-conscious about malar bags and have tried dozens of topical remedies with little success. Once bags on bags have formed, cosmetic surgery or other aesthetic treatments are usually the only way to effectively eliminate under eye bags. By treating sagging skin and fat in the lower lids, patients can look years younger and regain their confidence. The area around the eyes looks smoother, tighter, and more youthful. Patients will no longer wake up to puffy eyes and will look more awake and refreshed.
Common Methods for Treating Malar Bags (Lower Lid Filler, etc)
Even among talented plastic surgeons, treating festoons is not an easy task. There are many different methods that are used, depending on the situation. Each option has pros and cons, and different surgeons have their own opinions about which techniques are the best for creating a consistent, beautiful, and natural-looking result. Dr. Wulc prefers to use his own tested method, but many other techniques are used all over the country. Some of the common methods for treating festoons include:
Blepharoplasty
The popular eyelid surgery blepharoplasty is consistently a top facial plastic surgery each year in the United States. During the surgery, incisions are made in the natural creases of the eyelids and fat and skin are repositioned, tightened, and removed when necessary. Lower lid surgery is often used to address under eye bags, while upper eyelid surgery is more common for resolving excess skin. When blepharoplasty is performed on the upper and lower eyelids, the procedure can dramatically rejuvenate the eye area. However, this procedure may not be the best option for treating festoons alone. It is often best reserved for patients who require skin removal in the eyelids.
Direct Excision
Although sometimes used to treat festoons, direct excision under eye bag surgery is risky. It involves manually removing the fat or fat pads beneath the eyelids using surgical techniques. This can lead to scarring, depressions under the eyes, or other cosmetic irregularities, even when performed by a board-certified plastic surgeon.
Liposuction
A classic procedure for removing fat through small incisions, liposuction techniques have advanced a great deal in the last few decades. Gentler techniques allow sensitive areas like the eyes to be treated. However, this technique often produces inconsistent results and is not recommended for the treatment of festoons.
Lower Lid Filler Injections
Fillers and Botox are often used to help reduce under-eye bags and create a more youthful appearance. While fillers are excellent for treating lines and wrinkles, they can often make festoons worse. Some hyaluronic acid-based fillers will even draw water into the malar bags, increasing their size and prominence.
Luckily, the practice offers Filler Correction in the event of a previously botched lower lid filler treatment. Dr. Wulc will examine the work done and decide if a lower lid filler removal is necessary.
Dr. Wulc’s Preferred Treatment Method
In Dr. Wulc’s experience, none of the above treatments are ideal for treating festoons. He performs eyelid surgery using his own technique for correcting this common and challenging issue: a combination of microdroplet liposculpture and dual erbium laser resurfacing.
Microdroplet liposculpture involves using the patient’s own fat to carefully sculpt depressions and even out the amount of fat within the lower lid. Very little fat is needed, and the result looks extremely natural. Laser resurfacing helps to improve the skin quality in the area and restore a firm and supple look for more youthful skin.
Using Dr. Wulc’s innovative method, the removal of even the most problematic festoons is possible. Better still, treatment is typically performed in an outpatient setting. Patients may need only local anesthesia, as only small incisions are typically made. The surgery is painless and swelling lasts anywhere from seven to ten days.
Recovering from Lower Lid Surgery
Patients who undergo Dr. Wulc’s festoons treatment may experience bruises and swelling after surgery, especially if the procedure is combined with other treatments like an upper eyelid lift. About a week after surgery, patients should start to notice results as the swelling and bruising fades. Dr. Wulc will provide any pain medications and care instructions that may be needed to help keep patients comfortable and healing properly. Activity restrictions may be necessary to avoid complications.
Ideal Candidate
Men and women who struggle with “bags on bags” in the lower lids may be good candidates for under eye bags surgery. Healthy adults with realistic expectations are the best candidates for festoons surgery. This is a difficult condition to treat, and patients need to understand the limitations of the procedure. Fortunately, Dr. Wulc’s cutting-edge festoons treatment is more effective and consistent than almost any other treatment for this condition. Prior to the surgery, patients will meet with Dr. Wulc and discuss their goals and expectations.
Malar Bags Consultation
Dr. Wulc meets with each prospective patient in a one-on-one consultation at his Philadelphia area practice before creating any surgical plans. This allows him the opportunity to get to know the patient’s goals, perform an exam of the eye area, and ensure that the patient is healthy enough for surgery.
If Dr. Wulc believes that the patient is a good candidate for under eye bag surgery, he will go over his technique in detail and answer any questions the patient may have. If not, he will suggest some alternative options. Patients should come prepared with a list of medications and write down questions so they don’t forget to ask them during the meeting. This is a great opportunity for patients to explore their options and get to know Dr. Wulc and his staff.
FAQs
As with any surgery, there are minor risks involved with cosmetic eyelid surgery. Patients may experience scarring, infection, anesthesia complications, or a poor cosmetic outcome. These complications can be reduced by working with a board-certified surgeon who uses proper techniques.
After eyelid surgery, you will typically need to wait at least several days before wearing contacts again as the eye area heals. Dr. Wulc will be able to advise you on your limitations post-surgery and give you a timeline for resuming your normal habits, including wearing contacts.
Simply removing fat from the malar bags often causes more problems than it solves. Patients may end up with unfavorable scarring, depressions, or other cosmetic issues. Removing excess fat may “fix” bags on bags, but there are far too many drawbacks involved with the practice.
Most creams and topical treatments are ineffective for treating malar bags. Surgical intervention is almost always necessary for meaningful results.
Dr. Wulc will give each patient instructions for their recovery period, including exercise guidelines. Most patients will need to wait at least a week or two, often longer, before resuming strenuous exercise.
Yes. Many patients are interested in comprehensive rejuvenation and wish to improve several signs of aging at once. Patients with loose or excess skin, wrinkles, and excess fat may choose to combine malar bags treatment with procedures like upper eyelid surgery or fillers for unwanted wrinkles.
Are there any non-surgical treatments like Botox® or fillers that work on malar bags?
It is our opinion that Botox® and lower lid fillers can worsen festoons. Botox weakens the muscles that squeeze out edema. Certain fillers, such as Juvederm®, often draw water to them and worsen the bags. More often than not, our first treatment for festoons that are caused by fillers is to remove the lower lid filler.
What are malar bags?
Malar bags are caused by the accumulation of edema fluid at the junction of the ligaments that suspend the cheek and the junction of the lid and the cheek. They worsen with smiling and lessen when you lie flat. The cheek harbors the lymphatic that drains swelling from the undereye area. Because of this, patients often get a swelling below the eye in the mid-cheek. This is called a malar mound or mid-cheek mound. Patients are exceedingly self-conscious about them.
How do we treat malar bags?
The malar crease is formed beneath the malar bag and occasionally with very, very bad swelling creates a wrinkle. This wrinkle is effectively treated with a laser in the appropriate patient. We have great success with this technique and see patients from all over the United States for effective malar festoon treatment.
Some doctors excise malar bags. Malar bag excision is always associated with a scar. The scar heals but not always inconspicuously. It is not our preference and we rarely excise festoons. We find other treatments to be sufficient in the treatment of even the most severe. These include radiofrequency external treatments, Thermitight, Renuvion, midface lift and, most commonly, laser resurfacing.
Are there any homeopathic or naturopathic treatments for malar bags?
Some use green tea bags soaked, some use milk thistle, and some use cucumbers. Patients often say that they have tried these and failed. Other possibilities include Preparation H, which we have never seen success. Mechanical occlusion, i.e. tape, at night can be effective but is temporary. Most of our patients admit that they’ve tried everything, and elect to undergo more definitive, and hopefully curative, surgery.
Dr. Allan Wulc: A Pioneer Treating Malar Bags
For years, surgeons have struggled to treat severe under eye bags using traditional surgery procedures, fillers, and laser resurfacing. Dr. Wulc has dedicated himself to creating new techniques that are minimally-invasive, effective, and consistent. His method for treating malar bags doesn’t leave any scarring and offers natural-looking rejuvenation that helps patients regain their confidence.
Related Articles
- New Treatment for Malar Festoons and Big Eyelid Bags
- Festoons or Baggy Eyelids or BOTH?
- Festoons – What Are They and How Can You Get Rid of Them
Under Eye Bags Treatment
If you are struggling with large under-eye bags, then it may be time to stop using ineffective creams and seek help from a professional. Dr. Allan Wulc, MD, FACS, is board certified by the ABMS board in Ophthalmology. Additionally, he is board certified in Facial Cosmetic Surgery by the American Board of Cosmetic Surgery, where he served as a trustee for six years.
He is also board certified in plastic surgery by the American Board of Physician Specialists. He is further trained in Oculoplastic Surgery, Orbital Surgery, and Cosmetic Surgery and a diplomate of the nationally recognized and highly exclusive American Society of Ophthalmic Plastic and Reconstructive Surgery and is a Fellow of the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Cosmetic Surgery, and the American Academy of Surgeons.
He is known for his training and the incredible results he offers patients in Philadelphia. If you are interested in learning more about your options for treating festoons, please fill out this online contact form or you can call W Cosmetic surgery at (610) 828-8880 to schedule your consultation. Serving customers from Plymouth, Philadelphia, Main Line, PA and surrounding areas.
Why choose Dr. Allan Wulc
He is board-certified in:
- Ophthalmology by the American Board of Ophthalmology
- Ophthalmic Plastic & Reconstructive Surgery by the ASOPRS
- Cosmetic Surgery, Facial by the American Board of Cosmetic Surgery
- Plastic & Reconstructive Surgery by the American Board of Physician Specialties