Eye bag surgery

The skin of the upper and lower eyelids is particularly thin, as it must contract at least 5 times a minute with the palpebral beat.

What's more, it's subject to multiple external physical aggressions, such as wind, cold and UV rays.

Finally, it is subject to a strong action of gravity, all the more pronounced when there are excess fat deposits.

Under-eye bags tend to form with age, as eyelid skin loses tone, along with the underlying orbicularis muscle, so that fatty bags eventually herniate. At the same time, the loss of adipose and dermal volume aggravates the hollowing out of dark circles under the eyes.

It's the whole look that becomes tired and sluggish, causing aesthetic and psychological damage: your eyes betray what you are deep down, falsely reflecting the image of an amorphous person with no energy.

These bags under the eyes should not be confused with malar bags, which are caused by a relaxation of the orbicularis muscle associated with fatty melting of the cheekbone that normally supports it. Malar bags give the appearance of double dark circles, which considerably age the face.

Because surgical techniques are not the same, Dr Christelle Santini in Paris 16th always performs a precise analysis of the type of bags under the eyes, to see if fatty bags and malar bags coexist.

She then proposes fat pocket resection to remove the fatty hernias that appear under the eyes as a result of the relaxation of the palpebral muscle.

Dark circles under the eyes and puffiness are two distinct problems, each requiring its own specific treatment:

• Dark circles under the eyes, particularly hollow circles, result from a lack of volume under the lower eyelids, creating shadows and a tired appearance. They can also appear black due to pigmentation or thinness of the skin. Hyaluronic acid injections for dark circles under the eyes are the ideal solution for filling hollows, reducing shadows and reviving the radiance of the eyes, without the need for surgery.
• Bags under the eyes, also known as dark circles, are characterized by an accumulation of fat or fluid under the lower eyelid, forming a visible relief. This phenomenon weighs down the eyes and can give a puffy or aged appearance. Blepharoplasty is specifically indicated to treat this problem by removing excess fat or skin, for a long-lasting, harmonious result.

What to do before eye bag surgery?

• 1 to 2 plastic surgery consultations, with estimates and photographs.
• Legal 15-day waiting period between consultation and pocket surgery.
• Stop taking anticoagulants, stop smoking and stop taking the pill.
• Check-up by an ophthalmologist.
• Consultation with an anaesthetist.

How is the removal of dark circles under the eyes performed by Dr Santini in Paris?

• Intervention lasting less than an hour.
• Remove sutures between 4 and 7 days if necessary.
• Few inflammatory sequelae.

What are the after-effects of lower eyelid surgery?

• Social eviction for 5 to 8 days.
• Net result at 15 days.
• Rejuvenated, toned eyes.

Dr Christelle Santini devotes a preliminary consultation to listening to your needs, combining this with a precise clinical examination of dark circles.

To differentiate between a fat hernia and a malar pocket, she may have to press the eye into the socket. By compensation, the fat of the bags under the eyes comes out, but not the malar pocket located under the fat pocket.

Dr. Santini will also check the tone of the tissues, in particular whether or not there is excess skin to be resected. This examination will determine the choice of techniques, with associated procedures if necessary, such as filling hollow circles with hyaluronic acid or lipofilling.

Medical photos before and after dark circle surgery are taken to optimize follow-up and accurately assess the results obtained.

Dr Christelle Santini usually prescribes an ophthalmological check-up and an anaesthetic consultation, which is mandatory for all general anaesthesia.

It also always lists the most important medical precautions for obtaining informed consent, including:

• Stop smoking 1 month before and after eyelid surgery, to reduce the risk of skin necrosis.
• Stop taking aspirin, anti-inflammatory drugs or oral anticoagulants for 15 days prior to surgery, to reduce the risk of bleeding, with the cardiologist's authorization.
• Stop taking oral contraceptives 1 month before surgery, to reduce thrombo-embolic risk.
• Come on an empty stomach on the day of the blepharoplasty.

Dr. Christelle Santini performs the removal of bags under the eyes in a clinic, usually on an outpatient basis: the patient returns home the same day, without hospitalization. The procedure lasts an average of forty minutes, and requires either a light general anaesthetic or a so-called vigilant anaesthetic (neuroleptanalgesia).

The art of successful pouch surgery lies in carefully defining the contours to be incised, while respecting the identity of the eyes. The resection of fat pockets must be sufficient, without going to excess, which could ultimately hollow the eyes and harm the aesthetic result.

Fat removal alone can usually be done with a scarless blepharoplasty, by approaching the bags through the conjunctiva, the pinkish-white part inside the eyelid.

If this is not possible, the incision is made in the eyelid, carefully following the skin fold.

The simple removal of fat does not require deep tissue detachment, resulting in surgery with few inflammatory or painful after-effects.

If necessary, additional procedures can be combined, such as lipofilling of hollow circles or filling with a volumizing product.

Dr Santini advises a few days' social avoidance, as bruising or oedema may form on the operated eyelid.

Make-up cannot be applied for as long as any skin threads persist, i.e. 4 to 6 days.

The pain is very mild, so the simple analgesics always prescribed are not always useful. If necessary, cold compresses and eye drops can stop any local inflammation.

The patient should not return to sport for 2 weeks, or even 4 weeks in the case of swimming pools and water sports.
You must be very vigilant about UV rays for at least a month.

The rejuvenation of the eyes is considerable as early as the second week, once bruising and swelling have subsided.
Full remodelling is estimated to be definitive within 3 to 6 months, with rejuvenated, toned eyes.

• Rapid procedure, under short general anaesthesia or vigilant anaesthesia.
• Visible eye rejuvenation almost immediately
• Can be combined with other techniques to fill in dark circles.

The price of dark circle surgery can vary according to a number of criteria, including the complexity of the procedure. The price generally includes the surgeon's fees and those of the anesthetist.

Blepharoplasty with Dr. Santini starts at €3,500. A detailed estimate will be given to you during the initial consultation, allowing us to respond precisely to your expectations and inform you transparently about the total cost of the procedure.

What's the difference between a fat pocket and a malar pocket?

A fat pocket is a hernia caused by excess fat under the eyelid, while a malar pocket is linked to sagging cheekbones and muscles, creating a double ring.

What to do before surgery for dark circles under the eyes?

A consultation with the surgeon and a clinical examination are necessary. Smoking, anticoagulants and the contraceptive pill must be stopped, and an ophthalmological check-up and anaesthetic consultation must be carried out.

Are there any contraindications to this procedure?

Yes, contraindications include coagulation disorders, local infections, serious eye problems, or a general state of health incompatible with anesthesia. These can be identified by prior consultation.

How do I know if I need surgery for under-eye bags or if non-surgical treatment is enough?

Surgery is recommended for marked fat pockets or significant tissue sagging. Non-surgical treatments, such as injections, are suitable for light dark circles or hollowing without excess fat.

How long after the operation can I go back to work?

You can return to work in 5 to 8 days, once the bruising and swelling have subsided, depending on the type of professional activity.

Are the results of blepharoplasty permanent?

Results are long-lasting, but the natural aging of tissues can lead to further changes over time.

Can under-eye bag surgery cause vision complications?

Visual complications are rare. However, temporary swelling or irritation of the eyes may occur after the procedure, usually resolved with appropriate care.

What are the risks associated with cosmetic surgery for dark circles?

Although rare, risks include haematomas, infections, or unsatisfactory results in the event of poor post-operative management.

Can this procedure be combined with other treatments?

Yes, techniques such as lipofilling or hyaluronic acid can be combined to correct hollow circles and improve eye harmony.