Bags are folds of skin or subcutaneous tissue.
The main symptom of bags is their appearance which is considered unsightly.
The problem essentially affects old people.
Bags only rarely appear in young people: certain diseases such as thyroid gland diseases (Graves disease), congenital diseases and smoking are however predisposing factors.
Bags under the lower eyelids are often the consequence of skin aging: the skin fibres lose their elasticity and the skin becomes more flaccid. The collagen fibres simultaneously soften which causes fatty fibres (normally found in the eyeball) to protrude forwards. In younger people, bags are often caused by fat protruding and there is very little excess skin.
Over time, bags gradually deteriorate.
Bags are diagnosed by a clinical examination by an ophthalmologist.
Lubricating ointments, certain massages are the best prevention.
Some people have very flaccid eyelids (which means they can be easily stretched if pulled upwards). These people have a greater chance of the eyelid dropping again when skin is removed. When, during the operation, it is noted that the eyelid tends to stretch downwards, an additional lateral strengthening is carried out. Here, the eyelid is lifted from the side. For a few weeks, you may have a slightly Asiatic appearance, but this appearance disappears spontaneously.
The skin is kept intact and the operation is done via the inner side of the eyelid (the transconjonctival technique).
Stop taking anticoagulant drugs. This after consultation and agreement from your general practitioner. If you are using Marcoumar, a substitute treatment will be suggested in agreement with your general practitioner. If the anticoagulants prescribed for a general pathology cannot be stopped, it is then possible that surgery cannot take place.
Look for a cold compress (cool-pack or ice pack) at the pharmacist.
Pick up sunglasses or a protective hat.
Pick up a Dafalgan painkiller.
You do not have to be sober. Take all your drugs as usual (except the anticoagulants).
Do not put on mascara, make-up, earrings or necklaces. Favour wearing comfortable clothes. Do not wear your contact lenses.
Take in recent photos (representative). A photo will be taken before and after the operation so you can judge the change for yourself.
Mention to the nurse and doctor if you are allergic to some drugs.
The operation will last about two hours.
If a delay has built up with previous patients, you will need to take waiting time into account.
First of all, a drawing will be made on your skin using a felt pen to determine the incision.
Then, the whole face will be disinfected with Isobetadine and sterile drapes will be placed around your face like a turban (no drape will block your nose or mouth, this will not prevent you from breathing easily).
During the operation, you will not be able to touch your face for sterility reasons.
Then, the doctor will give you subcutaneous injections (lidocaine 2 % with 1:100,000 adrenaline). These injections are comparable to dentist’s injections. The anaesthetic takes effect immediately and lasts about one hour.
During the operation, you will have to sit up a few times, as this enables the operation’s effect to be judged better.
As suture material, non absorbable sutures are used (absorbable sutures cause a reaction that is harmful for the beauty of the scars). During this suturing, it is possible that the anaesthetic effect is wearing off. For this reason, you may feel the last sutures slightly. It is preferable not to re-anaesthetise for these last sutures because this increases the risk of swelling and subcutaneous bleeding.
At the end of the operation, an antibiotic ointment will be placed on your eyelids. Then, you will be given a cold compress, which you must leave on your eye for half an hour. When you return home, it is important to put on the cold compress every hour for 10 minutes. An alternative is to place a packet of frozen peas as this moulds easily onto your eyelids.
It is preferable to sleep with your head at a 45° angle to minimise swelling. The following morning you start cooling again, every hour for 10 minutes. This cooling is very important to reduce swelling, but only works during the first 24 hours after the operation. If you are in pain, you can take a Dafalgan (this does not contain anticoagulant substances).
How should the ice be applied? Ice can never come into direct contact with the skin. Wrap the ice in a face cloth. The best way is to push the ice against the lower eyelid and exert pressure upwards. Literally push the eyelid upwards.
Cool the eyelids with ice each hour (for 10 minutes). You are going to see the swelling will increase for up to 3 days after the operation, then it decreases.
For about a week the skin may be blue in colour, swelling may last up to 3 weeks. Bruising must not worry you, this will slowly disappear.
As long as there are sutures present, the wound cannot come into contact with water and it preferable not to wear make-up. No massaging eyelids for the first three weeks. Do not apply a dressing on the eyelids.
The sutures are removed 5 to 7 days after the operation. From now one, water can come into contact with the eyelids. Another check-up follows 4 weeks after the operation.
Avoid sun on your skin as this may cause ugly scars. This can be avoided by using a factor 60 total sunscreen or wearing a hat. A pair of sunglasses does not give sufficient protection.
In some patients, all excess skin cannot be removed as there is risk of problems in closing the eyelids.
The lower eyelid tends to hang down slightly. This is caused by the fact that the eyelid is slightly too flaccid. For this, a lateral attachment can be carried out. (Under local anaesthetic – see text: Bags under the lower eyelid and flaccid lower eyelids).
Scars are not only the consequence of the operating technique, they are also the result of skin reaction relating to the operation. Some people naturally form ugly scars. To improve scar healing, it is recommended not to expose the scar to sun. Smoking also has a harmful effect on the wound healing.
Eyelid correction leads to a temporary deterioration in the eyelids’ lymph ducts, which causes more swelling initially. During the operation certain nerve ends are cut and as a result hypersensitivity is possible in this skin area. The nerves recover within a few months.
In the suture locations small yellow cysts may develop. In most cases these resorb after a few months.
It may be that the swelling of the eyelids temporarily prevents the eyes from closing completely, which causes eye dryness. This problem can be treated by applying artificial tears solution.
In rare cases, post-operative bleeding may cause stressing of the tissues. This is an extremely serious complication which may even cause blindness. In this case, it is essential to contact your general practitioner immediately.