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Puffiness Under the Eyes – and the Risks of Surgery

Bags – or puffiness – under the eyes often give the impression of fatigue. It might not look good in the mirror, but you’ll doubtless hear comments from friends and family like “did you sleep badly?” or “why do you look so tired?” If you don’t like what you see in the mirror, what can you do about it?

Puffiness under the eyes: how do they arise? Moisture in the eyelids
In children, fluid accumulates in the eyelids (especially the lower eyelids) when they are tired or ill, but this disappears overnight when people sleep. This is also the case in adults, but this situation can be made worse by aging and smoking. Chronic inflammation attracts fluid to the eyelids and this stretches the skin of the lower eyelids. Further, as people age, their connective tissue changes, causing skin to become less elastic and sag and wrinkle, and the upper and lower eyelids to become weaker.

Fat in the eyelids
As connective tissue weakens, the fat around the eye socket can come forward and appear in the lower eyelids. This is called a fat prolapse. Unlike fluid, which can be pushed away, fat prolapses – literally bumps of fat – cannot, and can only be removed with surgery.

Before lower eyelid correction with the Hamra technique, performed by Dr. Paridaens (published with the patient’s permission).


After Hamra’s eyelid correction by Dr. Paridaens. There is a nice filling of the transition from the lower eyelid to the cheek, which means that the bags are practically gone! (Published with the patient’s permission).

Face bags: when to perform surgery?
If there is a clear sagging of lower eyelids as well as excess skin and proliferating fat (as opposed to subcutaneous lumps) then eyelid surgery can also bring cosmetic improvements to that region. These procedures are often performed under local anesthesia, but if more extensive surgery is required, this can also be performed under general anesthesia.


If there is a hollow tear gutter that contributes to a tired appearance, it can be filled with a natural filler: excess fat from the lower eyelids. Through surgery through a skin cut, this fat can be released and moved over the lower eye socket – this is known as the Hamra technique (Dr. Paridaens).

The excess fat in the lower eyelids is used to fill the hollow groove. Here you can see how the fat apron is fixed to the peritoneum (blue) under the lower eye socket edge. This means that filler injection is no longer required!

Puffiness under the eyes: which surgery?
If there is horizontal sagging of the lower eyelids with an excess of skin and fat, I usually opt for a lower eyelid correction, whereby access to the connective tissue bulkhead is obtained via a cut in the skin, a few millimetres below the eyelash edge. After this, the connective tissue shot can be ‘fed’, whereby the fat is brought back into the eye socket, where it functions as a ‘shock absorber’ for the eye. The fat can also be redistributed over the rim of the eye if there was a filling defect there (Loeb-Hamra technique). Rarely does fat really have to be removed. What is critical for the success of this technique is that the eyelid on the side is fixed to the bone, otherwise a poor-functioning and cosmetically disturbing droop will arise. This so-called canthopexy is an operation that many surgeons find difficult to perform. That is why such an operation is best performed by a surgeon who is experienced with lower eyelid surgery and often performs canthopexy.



A canthopexy provides fixation of the lower eyelid to the peritoneum so that the contour remains good: an important step in the lower eyelid correction


Young woman with tired appearance due to bags under the eyes on the basis of small fat loss and visible lower eye socket margin (reproduced with patient’s permission)


Lower eyelids after the Hamra technique: better filling of the eye socket edge resulting in fewer bags under the eyes (reproduced with patient’s permission)

Puffiness under the eyes: complications and how do you prevent them?
Complications are rare if the surgeon is trained in this technique and if the patient is healthy and has a healthy lifestyle. Complications consist of thread breakage, bleeding and infection. To prevent these complications, we provide instructions for aftercare: be careful with bending over, lifting and pressing for two weeks, and do not exercise during this period – although walking and cycling gently is fine. Cooling (15 min for each hour) of the eyelids with special bags – or even bags of frozen peas – for two days can help against swelling. If blood thinners are used, temporary cessation might be advised, depending on the circumstances, as there is an increased risk of bruising if patients have high blood pressure or if they take blood thinning drugs.

ELZA - Dr Dion Paridaens

Dr. Dr. Paridaens is a consultant orbital surgeon at ELZA Institute in Dietikon, Zurich, and has 25 years of experience with cosmetic eyelid surgery and has developed and published various eyelid surgery techniques. He operates at home and abroad. In view of his expertise, many clients, who are unfortunately dissatisfied with their eyelid surgery performed elsewhere, ask him for advice, often asking if he “can do something about it”. He also specializes in these reoperations, although he never operates on a patient if he thinks there is nothing he can do to improve their situation.

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Augeninstitut ELZA
4.8
Based on 109 reviews
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mike
mike
09:02 04 Jan 23
Overall as a 50 year old, who wanted to continue to avoid wearing glasses and/or contact lenses, my goal was 100% achieved with ELZA and Dr. Hafezi. I greatly appreciated the overall approach by Dr. Hafezi and his friendly and competent team in reviewing my vision at the start and following a comprehensive eye exam- the explanations of my options. For me I chose PRK in one eye for a monovision solution to correct short sightedness which was becoming more prevalent in night driving and sports such as skiing and cycling. PRK heals slowly but the outcome is worth the wait- and the cost- you use your eyes every waking moment- and for me I cannot see any reason not to pursue better vision with the ELZA team! A great quality of life enhancement!
Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient security.Thank you
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the city of Zürich and why he has been thrown away from University of Geneva.
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.
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Augeninstitut ELZA
4.8
Based on 109 reviews
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