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Prof. asoc. Dr. Stefan Gress

Tear Trough (eyebag) Correction

Professor Gress is one of the TOP specialists internationally

The expressiveness and appearance of the face
is largely determined by the eyes.
When it comes to evaluating the beauty of a person, the eyes play a crucial role.

Does this happen to you: people ask if you slept badly and say you look very tired and stressed?
Eye bags always give this impression, even when you don’t feel this way at all.
Knowing that you look tired is not nice and sometimes you even feel self-conscious about making eye contact.

Eye bags are mainly caused by aging and they are rarely congenital. They can only be removed using surgical correction. Creams, laser treatment to the lower eyelids etc. do not help as eye bags are not caused by changes in the skin but by changes deep under the skin due to fatty tissue protruding from the eye socket

The lower eyelid forms the lower part of the palpebral fissure and thus covers the lower part of the eyeball. It clings tightly to the eyeball and covers the lower edge of the iris. It is not as flexible as the upper eyelid and only plays a small part in closing the eye.

Nowhere else in the body is the skin as thin as on the lower eyelid. A ring-shaped muscle is located right under this thin eyelid skin (the orbicularis oculi muscle). This muscle helps to close the eye. The eye socket is located under this muscle. The eyeball, the muscles that move the eyeball and the optic nerve are located in the eye socket. The eye socket is lined with fat to protect the soft eyeball in the bony orbital wall. So the fatty tissue cannot protrude from the eye socket, it is closed off from the eyelid behind a fine membrane (orbital septum).

With aging, this membrane weakens and the fat can protrude from the eye socket. This is commonly referred to as an „eye bag“ or „tear sac“. It has nothing to do with tears, however, as the lachrymal gland is actually located in the upper outer part of the eye socket.

When the contour of the lower eyelid is even again and the deep shadows due to the protrusion of the eye bag are no longer visible, the tired look disappears and the eye appears more radiant, younger and fresher. As a rule, a completely smooth transition from the lower eyelid to the cheek is only ideal for women as it looks quite unnatural in men. Therefore, the “ideal” look is different for men and women.

Esthetic contour of the lower eyelids in a woman…
And Man

Eye bag correction does not consist of removing the fatty tissue protruding from the eye socket – instead, it is diverted downwards over the lower edge of the eye socket, thus achieving an even contour.

The side view of the lower eyelid changes from an undulating profile to a slightly convex smooth surface. This is best from an esthetic point of view.
Additional removal of fat tissue is only performed if eye bags are very pronounced.

The fatty tissue at the lower eyelid (eye bags) is displaced over the lower edge of the eye socket (front view) The fatty tissue at the lower eyelid (eye bags) is displaced over the lower edge of the eye socket (side view)
As a rule, the incision is made along the eyelashes on the lower eyelid, especially if it is also necessary to tighten the skin and muscles. In young patients who have no excess skin on their lower eyelid, the incision is made on the inside of the lower eyelid in the conjunctiva and is not visible from the outside.

The fatty tissue on the lower eyelid (eye bags) is placed over the lower edge of the eye socket (view from the front)
The fatty tissue on the lower eyelid (bags under the eyes) is placed over the lower edge of the eye socket. As a result, the protrusion of the fatty tissue (tear sac) disappears and the contour of the lower eyelid becomes smooth (view from the side)

The operation is carried out under sedation or general anesthesia. Local anesthesia alone is not enough as no movement is allowed during the procedure.

Excess upper eyelid skin may also be related to a drooping of the forehead and thus the position of the eyebrows. In this case, a forehead lift or a combination of upper eyelid lift and eyebrow lift would be the right therapy.

to stabilize the lower eyelid, a small muscle flap is cut around the subcutaneous muscle and attached to the outer edge of the bony orbit under slight tension
only after that the excess skin on the lower eyelid can be removed

The procedure is performed under general anesthesia. In some circumstances, simple corrections to the lower eyelid are possible under local anesthetic, particularly if the skin simply needs to be tightened. The eye bag correction operation is somewhat more complicated, and it is particularly important that the patient does not move.
So general anesthesia is best.
However, inpatient stays are not necessary. After the operation, you can relax for as long as you need in our clinic while waiting to be collected. We will change the dressing the next day. The sutures are removed after 4-5 days.

As the procedure is carried out under general anesthetic, we require a routine preparation by your general physician, i.e. an ECG, blood count and coagulation tests. Under no circumstances should you take blood-thinning medication (ASA 100, aspirin, Marcumar, etc.) during the 14 days before the procedure. Please make sure that someone is ready to collect you after the procedure as you may not drive a car afterwards.
We are also happy to book a taxi for you.

A light pressure bandage is applied to the eyes straight after the procedure. This is removed within around 30 minutes. The eyes are cooled. You should sleep on your back with your upper body slightly raised for 14 days afterwards. The sutures are removed after 4-5 days. The plasters will be changed on the day after the operation. You will have to wear plasters on your lower eyelids for a total of 12 days to reduce any significant swelling.
You should not attend any important social events for around 3 weeks if you don’t want people to know about your surgery. You can get through the first phase easily enough by wearing sunglasses.

The German law on the advertising of medical products forbids the use of before and after pictures for cosmetic procedures in Germany. We can have a look at these as part of your personal consultation.
By way of illustration, here is the result of a medically indicated procedure:

before correction
after correction
before correction
after correction
before correction
after correction

Frequently Asked Questions

 When will the swelling go down completely?

 Why do I have to sleep on my back for 14 days after the procedure?

 When can I use the sauna and go out in the sun again?

 What are the costs?

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Unique combination of the highest demands in terms of precision and aesthetics

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Professor for Plastic Surgery

Professor and lecturer
in Plastic Surgery

Experience makes the difference

  • More than 10000 procedures
  • Over 30 years of experience
  • Inventor and developer of the “Composite Reduction Labiaplasty”
  • Internationally recognized top specialist
  • Author of the international textbook “Aesthetic and Functional Labiaplasty” (Springer Publishers)
  • Professor and Lecturer in Plastic Surgery

In the most important national and international specialist societies

American Society of Plastic Surgeons

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen

International Confederation for Plastic, Reconstructive and Aesthetic Surgery

International Society of Aesthetic Plastic Surgery

The Aston Baker
Cutting Edge
Aesthetic Surgery

2018, New York

Faculty Member
The greatest honor for
a Plastic Surgeon