Having bags or dark circles under your eyes after eyelid surgery can be worrying. However, there are several potential causes for this common postoperative side effect. In most cases, bags under the eyes after blepharoplasty are temporary and can be improved with time and proper care.
Swelling and bruising
The most common reason for baggy eyes after eyelid surgery is normal postoperative swelling and bruising. Eyelid procedures involve making incisions and alterations to the delicate skin and tissues around the eyes. This causes inflammation as the area heals. Swelling peaks at around 2-3 days after surgery and can persist for 1-2 weeks. As the swelling resolves, it often leaves behind some temporary bagginess or hollowness under the eyes. Be patient, as it can take several weeks for all the swelling to fully subside. Using cold compresses can help minimize swelling and speed healing.
Retention of orbital fat
Sometimes, bagginess after blepharoplasty is caused by retention of excess orbital fat pockets around the eyes. Orbital fat prolapsing forward creates the appearance of under eye bags. During blepharoplasty, the surgeon trims and repositions this fat. However, it is possible for some fat to remain and continue to protrude. This may be more noticeable as the swelling goes down. Additional steroid injections or revision surgery may be required to smooth the area by better contouring the fat pockets.
Lower eyelid retraction
In some cases, lower eyelid retraction or ectropion causes lower lid bagginess after surgery. This is when the lower eyelid turns outward and sags away from the eye instead of hugging the eye contour. It creates both a baggy look and eye exposure/irritation. Risk factors for eyelid retraction include aggressively removing too much lower eyelid skin, weakening the lower eyelid muscle, or scarring. Mild cases often resolve on their own as healing progresses. Severe eyelid retraction may require additional surgical correction.
Fat graft absorption
If fat grafting was done during lower blepharoplasty, it is normal to have some postoperative bags and hollowness as the transferred fat is reabsorbed. Approximately 25-40% of injected fat grafts are absorbed by the body. As the swelling resolves, you may notice bagginess in areas where some of the injected fat has been absorbed until remaining fat recontours the area. Allow several weeks for the final results to become apparent.
Postoperative dryness and allergies
Dry, irritated eyes and allergies after surgery can exacerbate under eye bags and dark circles. This may be from eye drops used during surgery, swelling affecting the tear ducts, or simply not blinking as often due to pain and swelling. Using preservative-free lubricating eye drops, drinking lots of water, taking antihistamines, and applying cool compresses can help soothe dryness and inflammation.
Lifestyle factors
Lifestyle habits also impact swelling and healing after eyelid surgery. Factors like salt intake, alcohol use, smoking, and sleep deprivation can contribute to fluid retention, swelling, and dark under eye circles. Limiting these activities, elevating the head while sleeping, and using cool compresses facilitates proper drainage and recovery.
Reasons bags under eyes persist long-term after blepharoplasty:
- Thinning skin with age allows underlying fat and muscles to show through more
- Gravity, muscle relaxation, and loss of skin elasticity over time
- Genetics – some people are just prone to under eye bags
- Allergies causing chronic sinus issues and inflammation
- Lifestyle factors like poor sleep, dehydration, salt intake
- Hollow tear troughs creating shadow effect
- Need for additional fat treatment or skin tightening procedures
- Delayed healing due to health issues, smoking, not following post-op care instructions
When will bags under my eyes go away after blepharoplasty?
Here is a general timeline for when you can expect to see improvement in under eye bags after eyelid surgery:
- First 1-2 weeks – Swelling and bruising peaks, eyes appear puffy and swollen
- 2-4 weeks – Most swelling subsiding, early results visible but fluid retention still present
- 1-2 months – Swelling and bruising fully resolved, good idea of final results
- 3-6 months – Final results visible as last bit of swelling resolves
- 1 year – Maximum results are apparent
However, some residual swelling, numbness, and subtle asymmetry may persist for several months to a year before the eyes fully refine and adjust. Be patient, as the final results are rarely obvious immediately. Follow your surgeon’s post-op care instructions diligently to facilitate proper healing.
Tips to minimize bags under eyes after blepharoplasty
While bags under the eyes are common after surgery, there are things you can do to help reduce and improve their appearance:
- Use cold compresses to minimize swelling
- Sleep with head elevated on extra pillows
- Avoid excess salt, alcohol, smoking
- Drink plenty of fluids
- Take bromelain supplements to reduce inflammation
- Take arnica to control bruising
- Use preservative-free eye drops for dryness
- Gently massage the area to improve circulation and drainage
- Apply topical caffeine, vitamin C, retinol creams to tighten skin
- Try facial exercises to strengthen eyelid muscles
- Get enough sleep
- Wear sunglasses to protect delicate skin from sun exposure
If bags under the eyes do not start to improve within a few weeks, consult your plastic surgeon. Additional steroid injections, laser treatments, or surgical revision may be recommended for persistent bags, hollowness, or eyelid retraction issues.
When to see your doctor
Contact your surgeon if you have any of the following:
- Increasing pain, swelling, redness in the eyelids
- Issues with vision, double vision, inability to close eyes
- Eyelid or eyeball discomfort, irritation, fever
- Excess tearing, discharge, crusting around eyes
- Asymmetric appearance, one eye more baggy than the other
- Worsening hollowness, tear troughs, dark circles
- No improvement in bags under the eyes after 4-6 weeks
While ups and downs during the recovery process are normal, alert your doctor about any concerns to avoid complications and get the best possible cosmetic outcome from your blepharoplasty procedure.
Conclusion
Mild to moderate bags or circles under the eyes are common after eyelid surgery due to normal postoperative swelling and bruising. Patience is required while healing runs its course. However, if excessive bagginess persists long-term, there are surgical and non-surgical treatment options available for revision and improvement. Work closely with your plastic surgeon and follow all postoperative care instructions to help minimize lasting under eye bags or hollowness after blepharoplasty.