Comparison of eye bag surgery: difference between Transcutaneous and Transconjunctival

Eye bags are a common phenomenon with age, making us appear older and more tired than we actually are. For those with moderate to severe eye bags, eye bag surgery (lower eyelid blepharoplasty) is often chosen. There are two types of eye bag surgery: traditional skin-tightening surgery (transcutaneous) and minimally invasive eye bag surgery (transconjunctival), depending on the severity of the eye bags and the amount of excess skin. First, let’s understand what eye bags are and how they form.

What Are Eye Bags?

“Bags” under eyes are the swelling or puffiness under the eyes. They are common as we age, and often make us look tired or older than we actually are. Eyebags are due to the weakening of the lower eyelid tissues, including the skin and the supporting muscles. The fat that helps support the eyes can then move into the lower eyelids, resulting in bulging eyebags.

What causes eyebags?

1. Allergies: Allergies may lead to repeated rubbing and scratching of eyelid skin

2. Medical conditions: Some health conditions such as renal disease and thyroid eye disease can cause eyes to become swollen

3. High Salt Diet: Fluid retention, especially upon waking or after a salty meal (usually transient only)

4. Natural Aging Process: Loss of collagen due to aging causes skin laxity

5. Genetic: Family history will make someone prone to have eyebags earlier

6. Fatigue or exhaustion: Lack of sleep or overuse of eyes on devices such as computers or mobile phones

7. Alcohol and smoking: Drinking of alcohol and smoking contribute to skin laxity

Can Eye Bags Be Prevented?

While we cannot stop the natural aging process, we can prevent the formation of eye bags by improving our lifestyle habits. Here are some effective methods:

1. Ensure sufficient and quality sleep every night.

2. Reduce prolonged use of electronic screens.

3. Quit smoking.

4. Reduce alcohol intake.

5. Adopt a low-salt diet.

Additionally, using high-quality skincare products with sun protection can help delay skin sagging.

Eye Bag Surgery

Eyebag surgery is a relatively simple surgery and it is usually an outpatient procedure which can be carried out in a clinic or hospital under local anaes thesia. You can have some medicine to help you relax, or if you prefer, an anaesthestist can give you intravenous sedation so that you can sleep during the procedure. An eyebag surgery usually takes about an hour to 90 minutes.

Types of Eye Bag Surgery

The principles of eyebags surgery (lower blepharo plasty) are to remove the excessive fat, to tighten the muscle layer and to excise the excess skin, if needed. There are two options used: Open or Closed approach, depending on the severity of the eyebags and the amount of excess skin. Your surgeon can discuss which is the best option for you basing on your condition.

Transcutaneous (Open Surgery)

With a transcutaneous approach, the surgical cut is made on the lower lid a little below the eyelash line. During the procedure a small amount of fat, which is causing the bulge, is removed. Also, the muscle is strengthened and the lax skin is trimmed.

Transconjunctival (Closed Surgery)

With a transconjunctival approach, there is no scar ring visible after surgery. The cut is made inside the lower eyelid to remove the eyebag fat only. This is a good option where the skin is relatively tight and not much excess skin.

Comparison of Eye Bag Surgery

Transcutaneous (Open Surgery)	Transconjunctival (Closed Surgery)
Minor skin scar	No visible scar
For moderate and severe eyebags	For mild eyebags, with relatively tight skin
Longer recovery time (2-6 weeks)	Short recovery time (1-3 weeks)
More long-lasting result	No stitches required

Recovery Time for Eye Bag Surgery

Eyebag surgery is a relatively simple surgery and recover period typically is not long. Most people go back to work after 1 to 2 weeks. However, there may still be some swelling at this point which continues to improve for 3 months. Any major swelling or bruising, if any, goes away within 2 weeks in most cases.

Post-Care for Eye Bag Surgery

As the eyebag surgery is usually an outpatient procedure, you can go home soon after the surgery. You should prepare a pair of sunglasses to protect your eyes and have someone to accompany you home. Driving a car or operating on a machine after the surgery is absolutely not recommended.

Other precautions:

Rest at home for one day

Follow your surgeon’s instructions regarding medication, apply eye ointment /eye drops, and attend follow up sessions

Use ice pack for 2 days after surgery to minimize swelling and bruising

No hot shower or bath for the first 2 days after surgery

Avoid alcohol and spicy food for the first 2 days

Avoid vigorous exercise for 1 week after surgery

In case of open surgery, stitches are usually taken off after 7 days and you may use eye cosmetics after that

Avoid wearing contact lens for 10 days after surgery.

Although the results of surgery are much longer lasting compared to other treatment options, ongoing changes due to aging means some people may find their eyebags coming back and may opt to repeat the surgery after 5 to 10 years.

Are the results of eyebag surgery permanent?

Eye Bag Surgery: Limitations and Unsuitable Candidates

Person would not be suitable for eyebag surgery when they have:

1. Unstable medical conditions such as hypertension, heart diseases, diabetic and thyroid diseases

2. Bleeding or clotting disorders, including taking high dose anticoagulants

3. Severe dry eye discomfort

4. Recent eye surgery such as LASIK or cataract surgery

5. High consumption of cigarettes (heavy smokers).

Risks of Eye Bag Surgery

Risks include: bleeding and bruising, wound infection, prolonged swelling, incomplete removal of eye bags, scarring, eyelid malposition, vision problems (rare), and abnormal tearing.

These include: bleeding and bruising, wound infec[1]tion, persistent swelling, residual eyebag, scarring, eversion of eyelids (ectropion), vision problems (rare), abnormal tearing. While the eyebag surgery is generally well-tolerat[1]ed, no cosmetic procedure is without risks—and eyebag surgery is no exception. Following your doctor’s instructions in the recovery period is vital to achieve and maintain your results.