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.
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 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.
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:
Good to know
Frequently Asked Questions
The visible swelling will go down after 2-3 weeks. However, it will take up to 6 months until any minor residual swelling has completely disappeared.
If you have also undergone skin or muscle tightening at the lower eyelid, the sutures may come undone if you lie on your side on your cheek so you should avoid doing this.
UV radiation has a negative effect on scar formation. You should avoid tanning booths and direct sunlight for 6 months after the procedure or wear sunglasses and use a sunscreen with a high protection factor. You can go to the sauna again after 2 months.
The procedure lasts around 3 hours. The cost is EUR 5,000 to 8,000, depending on the work needed. This is based on the initial findings, the degree of tissue slackness, how pronounced the eye bags are, etc. In addition, there are the anesthesia costs for the anesthetist, who charges for his/her services separately (around EUR 1,200 to 1,500). If it is a purely cosmetic procedure, statutory VAT of 19% applies. If there are functional complaints (chronic eye sensitivity, watery eyes, a sensation of pressure, etc.), then it is seen as a medically indicated procedure and VAT does not apply.