When considering removing sagging under the eyes by cosmetic surgery, there are roughly two methods: the “lower eyelid incision method (cutting method)” and the “transconjunctival degreasing method (non-cutting method)”. Detailed explanation of each operation under the supervision of a doctor! We’ll also show you how to prevent puffiness and dark circles under your eyes.
Table of contents
- What causes puffiness and dark circles under the eyes?
- Self-check for sagging under the eyes and dark circles!
- Four types of sagging under the eyes and dark circles
- Two ways to remove bags under the eyes with cosmetic surgery
- What is the difference between the lower eyelid incision method and the transconjunctival degreasing method?
- Treatment that can be combined with sagging under the eyes
- How to prevent and care for puffiness under the eyes
- Preventive care is important for sagging and puffiness under the eyes!
What causes puffiness and dark circles under the eyes?
Sagging, dark circles, and puffiness under the eyes are caused by the weakening of the eyeballs due to aging, and the orbital fat (the fat that acts as a cushion to protect the eyeballs) is pushed forward.
Under the eyes, there are two bags called “eye bags” and “namida bags”, and it is the “eye bags” that cause sagging, dark circles, and puffiness under the eyes.
The eye bags are made of orbital fat, and with age, sagging and puffing appear, and shadows and dents appear underneath, resulting in dark circles (black bears). Sagging eye bags can also lead to deep wrinkles called Golgo lines.
Self-check for sagging under the eyes and dark circles!
Let’s self-check the sagging, hollows and dark circles under the eyes with the checklist .
- Dark circles under my eyes are chronic and won’t go away
- I feel like there is a step in the dark circles under my eyes
- Dark circles under the eyes are sunken
- I feel that the area between the shadow line of the dent and the eye has swelled.
- The puffiness under my eyes seems to be getting bigger
- eyelids feel heavy
- Difficult to draw eyeliner when applying makeup
If there is something that applies to you, there may be changes in your eyes.
Four types of sagging under the eyes and dark circles
The types of sagging, puffiness, and dark circles under the eyes differ from person to person, and can be broadly divided into four types.
V-shaped type with conspicuous sagging and bulging
The type that has conspicuous sagging and bulging under the eyes in a “V-shaped” shape when viewed from the front has little mailer fat (subcutaneous fat that exists from the cheekbones to the nasolabial fold), or sagging has occurred due to some cause. The reason is that there is
A type in which puffiness can be seen all over the eyes
It is said that Japanese people often see puffiness under the eyes, and with age the orbicularis oculi muscle (the muscle that surrounds the eye and opens and closes the eyelids) weakens, causing the eye socket to become swollen. It happens when fat protrudes forward.
The general sagging and puffiness under the eyes can make you look older. Aging is a major cause, but the shape of the cheekbones is also thought to play a role.
A type that shows conspicuous dents and shadows under sagging and swelling
This is the type where you can see both sagging and puffiness under the eyes, as well as depressions and shadows. The greater the amount of orbital fat, the more conspicuous the swelling and sagging under the eyes, and the more conspicuous the dents and shadows are.
If you remove too much orbital fat to remove sagging and puffiness under your eyes, you may end up with sunken areas under your eyes, which will make the dents and shadows stand out.
A type in which wrinkles and sagging of the skin are conspicuous due to a decrease in firmness
The skin contains components such as collagen, elastin, and hyaluronic acid, which maintain the firmness and elasticity of the skin. However, the amount of collagen peaks in the 20s and decreases, and it is said that the amount of collagen in the 60s is half of what it was in the 20s.
As a result, the ability of the skin to retain elasticity and moisture decreases, and wrinkles and sagging around the eyes become noticeable. When you have more opportunities to look at your smartphone or computer, your gaze becomes fixed and the muscle strength around your eyes tends to weaken.
Two ways to remove bags under the eyes with cosmetic surgery
If you want to remove the sagging under the eyes, it is difficult to improve with methods such as massage around the eyes, orbicularis oculi muscle training, esthetics, and skin care. These methods can prevent sagging under the eyes and care to prevent them from getting worse, but they cannot remove the sagging that has already occurred.
If you want to treat sagging, swelling, or dark circles under your eyes, there are two main cosmetic medical treatments: the lower eyelid incision method (cutting the skin) and the transconjunctival degreasing method (not cutting the skin). there is one
If you are concerned about the sagging of the upper eyelids, such as ptosis caused by aging, you will need a different treatment than the sagging under the eyes . Surgery for blepharoptosis includes levator anterior rotation, excess skin excision, and frontalis lifting.
Lower eyelid incision (method of cutting the skin)
The lower eyelid incision method is a method of performing surgery by making an incision of about 1 mm from the lower eyelashes.
There are two types of lower eyelid incision: the “skin flap method” in which the skin is excised and pulled upwards, and the “Hamura method” in which the orbital fat is moved at the same time as the skin is excised.
With the skin flap method, the orbital fat may be removed according to each patient’s condition of sagging and puffiness under the eyes.
The Hamra method improves sagging and puffiness under the eyes by moving the orbital fat to the dented area under the eyes without removing it. In the case of the Hamra method, surgery may be performed using the “back Hamra method”, in which an incision is made from the back side of the lower eyelid so that the wound cannot be seen from the front side.
After that, excess skin is removed to improve sagging, dark circles, and wrinkles, and the scar is carefully sutured along the lower eyelashes to make the scar less noticeable.
In the lower eyelid incision method, excess skin is removed, so it can be expected to improve not only sagging and dark circles but also crepe wrinkles, and the skin is cut, leaving scars, but if you cut the eyelashes at the very last minute, they will be almost inconspicuous. There are individual differences, but the redness of the wound disappears in about 3 to 6 months.
Transconjunctival degreasing method (method that does not cut the skin)
If you want to treat sagging, puffiness, and dark circles under your eyes without cutting them, a treatment called transconjunctival degreasing is performed.
The orbital fat of the lower eyelid exists in three parts: the outer, central, and inner parts, but the central and inner parts tend to accumulate more. In transconjunctival delipidation, an incision is made in the conjunctiva behind the lower eyelid and excess orbital fat is removed.
Since only a small hole of about 5 mm is made, suturing may not be necessary, and the wound will be closed at an early stage. Since the orbital fat is removed from the back of the lower eyelid, the scar is invisible from the front.
What is the difference between the lower eyelid incision method and the transconjunctival degreasing method?
When removing sagging under the eyes, there are the lower eyelid incision method and the transconjunctival degreasing method as introduced above, but the two treatments mainly differ in the following points.
- scar (with or without incision)
- excision of excess skin
In the case of the “lower eyelid incision method”, the downtime (the period until the wound heals and you can return to your daily life) is long because the skin is incised. However, since excess skin can be removed, it can be expected to improve sagging and crepe wrinkles caused by stretched skin.
In the case of the “transconjunctival degreasing method”, a small hole is made on the back side of the lower eyelid to remove the orbital fat, so there is no scar and less downtime than the lower eyelid incision method. However, excess skin is not removed, so if the skin under the eye is stretched, the area where the orbital fat was removed may sag.
Treatment that can be combined with sagging under the eyes
If you just remove the sagging under the eyes, the area where the orbital fat has been removed may become dented or sagging. Therefore, in combination with removing sagging under the eyes, fat injection, hyaluronic acid injection, PRP skin regeneration therapy, etc. are sometimes performed together.
Fat injection is a treatment that removes impurities from your own fat collected from your stomach or thighs and injects it. By injecting into the sunken area under the eyes and areas where sagging is noticeable, the skin is raised and plumped.
In the case of transconjunctival delipidation, fat injection may be combined for treatment.
Under-eye wrinkle removal (PRP skin regeneration therapy)
If wrinkles under the eyes are a concern, PRP skin regeneration therapy (platelet-rich therapy) may be used to remove wrinkles around the eyes.
PRP skin regeneration therapy is a method of injecting platelets and white blood cells extracted from your own blood.
hyaluronic acid injection
Hyaluronic acid injections may be used to treat not only sagging and puffiness under the eyes, but also pits and shadows.
With hyaluronic acid injection, instead of removing orbital fat, hyaluronic acid preparations are injected into the hollows to make them plump and make the sagging and puffiness under the eyes less noticeable.
How to prevent and care for puffiness under the eyes
Here are some tips on how to prevent and treat puffiness under your eyes.
5 minute facial muscle training
Poor blood circulation and weakened muscles around the eyes are one of the causes of sagging and dark circles under the eyes.
It is also recommended to incorporate easy 5-minute facial muscle training and aim to improve sagging and dark circles around the eyes.
Orbicularis oculi muscle training to squint and keep thin eyes
When the orbicularis oculi muscle weakens, it causes sagging around the eyes, dark circles, and fine wrinkles. There are various ways to train the orbicularis oculi muscle, but the easiest way is to “squint your eyes and keep them thin”.
- Apply force to the lower eyelids and narrow your eyes to make them look thinner.
- keep this state for 20 seconds
- Do 3 sets of 5 reps a day
This orbicularis oculi muscle training does not put a strain on the body, and it is recommended because it can be done easily whenever you notice it.
use eye care cosmetics
The skin around the eyes, including under the eyes, is thin and delicate, so it is important to take good care of it every day. Moisturize your eyes by using eye care products .
- Highly moisturizing
- Choose products that contain firming ingredients (retinol, niacinamide, etc.)
- Items in a price range that can be used generously every day
Please try to find the one that is perfect for you while keeping the above points in mind when choosing eye care cosmetics.
proper skin care
Incorrect skin care, such as rubbing eye makeup or massaging strongly, can damage the delicate skin around the eyes.
It is important to take proper measures against UV rays and perform daily skin care in the correct way .
Preventive care is important for sagging and puffiness under the eyes!
Sagging and puffiness under the eyes is a problem that is difficult to improve greatly with skin care, massage, training, etc. once it can be done.
If you are concerned about the sagging under the eyes and want to fix it, you can treat it with cosmetic surgery, but there are risks such as downtime and scarring.
In order to prevent sagging and puffiness under the eyes from getting worse, it is important to avoid the wrong skin care and take careful preventive care.
Supervisor Profile: Masashi Komatsu, Director of Mizuho Clinic
Kiyoshi Komatsu Graduated from Sapporo Medical University and entered the department of plastic surgery at Sapporo Medical University. She graduated from Sapporo Medical University Graduate School and obtained a doctorate in medicine. She is a Postdoctoral Fellow at the Florida Moffitt National Cancer Center. He is an assistant professor of plastic surgery at Sapporo Medical University, chief of plastic surgery at Sunagawa Municipal Hospital in Hokkaido, joined a major plastic surgery clinic (concurrently served as director), and is the director of Mizuho Clinic .
He is a plastic surgery specialist of the Japan Society of Plastic Surgery, a full member of the Japan Society of Aesthetic Surgery, and a doctor of medicine. What we aim for is to overcome the complex of each and every one of them, and to have a smile full of confidence and a radiant feeling. For that reason, I would like to continue to fulfill my mission as a cosmetic surgeon by earnestly getting close to my patients.