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Preservation (Scarless) Eyebag Surgery

Under-eye bags commonly cause people to look tired despite adequate sleep and rest. Many individuals experience a lack of energy in their facial appearance due to these eye bags. Some individuals develop this condition early in life due to genetics, resulting in an aged appearance.

Preservation eyebag surgery aims to minimise the removal of fat during the procedure, while still refreshing and rejuvenating the appearance to maintain a natural, unoperated look.

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Dr Terence Goh

MBBS

MMed

MRCS

FAMS

Eyebag-Surgery-d Eyebag-Surgery-d
Preservation (Scarless) Eyebag Surgery

My Philosophy

“Eyebag surgery has transitioned from aggressive procedures involving extensive fat and skin removal with prolonged downtime to more refined approaches that prioritise natural results. These modern techniques preserve lower eyebag fat, redistributing the excess into the sunken tear trough area. This method enhances skin firmness while allowing for careful, conservative fat removal. The results are more natural, with shorter downtime and faster recovery. Whenever feasible, we recommend opting for the preservation eyebag surgery technique.”

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Why Do We Have Dark Eye Circles?

There are many causes of dark eye circles:

  • Insufficient sleep
  • Allergies
  • Skin pigmentation
  • Thin skin
  • Prominent veins
  • Eyebags

Not all dark eye circles are caused by eyebags, and certainly not all cases should be treated with eyebag surgery. Addressing the underlying causes is often key to effective treatment.

Certain cases of dark eye circles can be treated with hyaluronic acid fillers. This offers a temporary solution, but it is a challenging area for filler application.

For patients with very thin skin or those who have had excessive fat removed, resulting in a sunken appearance, structural fat grafting can be beneficial. This procedure helps improve the thickness of the skin, reducing the appearance of dark eye circles.

Image What causes eyebags

What causes eyebags?

Preservation (Scarless) Eyebag Surgery

Tear Trough (TT) Ligament

The tear-trough ligament is a key anatomical structure that marks the lid-cheek junction. This ligament causes the fat above to bulge and acts as a restraint creating bulgy and puffy eyes.

Preservation (Scarless) Eyebag Surgery

Laxity of skin and muscle

With aging, the laxity of the overlying tissues that you can see or feel, such as the skin and muscle and tissues that you are unable to see, such as the orbital septum allows the eye fat around the eye to bulge creating puffy eyebags, giving rise to a tired or aged appearance.

Preservation (Scarless) Eyebag Surgery

And what about the (fat) eyebag?

In truth, the fat around the eyes does not increase with ageing. In fact, as you get older, the fat may reduce (atrophy). Hence, modern techniques focus on the preservation of fat, striving to avoid removing it. Instead, the aim is to reposition as much of the fat as possible into the cheek.

Different Types of Eyebags

Eye bags can appear in a variety of types, each highlighting common under-eye concerns. Pre-operative evaluation determines the type of surgery required.

Type+I+Eyebag-1920w

This condition causes subtle hollows beneath the eyes, primarily due to mild volume loss in the tear-trough region, resulting in a slight shadowing or indentation but no significant puffiness.

Patients with a Type I eyebag tend to be young patients who have a genetic predisposition to prominent eyebags. They may only require release of the tear trough ligament through a hidden incision without the need or minimal manipulation of the eyebags and certainly no need for any skin excision.

Some patients who had previous eyebag surgery but with no release of the TT ligament may notice a “recurrence” or suboptimal result after eyebag surgery. Release of the ligaments will help this group of patients.

Type+II+Eyebag-1920w

This type combines both under-eye hollows and visible fat protrusion, resulting in a distinct lid-cheek junction.

Patients with a Type II eyebag have a TT deformity as well as significant eyebag fat causing a bulge and a lid-cheek segmentation. These patients tend to be in the 30-40s and have good skin elasticity. There is minimal wrinkling of the skin.

For these patients, a release of the TT ligament and recontouring of the fat will be sufficient to create a flat lower eyelid contour.

Type+III+Eyebag-1920w

Severe eyebags are characterised by prominent fat bulging, significant skin sagging, and wrinkles. This results in a more pronounced aged or fatigued appearance and requires a more extensive intervention to restore a youthful look.

Patients with a Type III eyebag tend to be older (above 45) and may have wrinkles suggesting increased skin laxity and excess skin and eye muscle. Alongside the TT deformity and the excess fat in the eyebags, there will be significant segmentation of the lid-cheek junction, giving a tired or aged-looking appearance.

These patients are usually good candidates for skin and muscle excision and repositioning of the lower eyelid fat.

Indications for Preservation Eyebag Surgery

Preservation eyebag surgery is suitable for individuals experiencing various under-eye concerns. Below are the key conditions that indicate this procedure may be beneficial.

  • Puffiness or Under-Eye Bags

    Puffy or protruding fat pockets beneath the eyes, often caused by genetics or ageing.

  • Hollowness Under the Eyes

    Displaced fat or tight ligaments can lead to hollowness beneath the eyes. A hollowed under-eye area can sometimes be addressed by repositioning fat during the procedure.

  • Sagging Skin

    Loose, wrinkled skin under the eyes is common with ageing or loss of skin elasticity and contributes to an overall aged and fatigued appearance.

  • Resistant to Non-Surgical Treatments

    When non-surgical treatments, such as fillers or creams, fail to address under-eye concerns, this procedure may be useful, particularly for persistent puffiness or hollowing.

  • Dark Circles

    Shadows caused by fat herniation or skin thinning contribute to dark circles. However, while the surgery improves under-eye contours, it does not directly treat pigmentation issues.

Understanding Preservation Eyebag Surgery

New approaches to eyebag surgery focus on preserving the precious lower eyelid fat by re-grafting some of it into the tear-trough hollow while minimising the amount removed. This technique, referred to as preservation eyebag surgery, aims to achieve a more natural result. The procedure creates fuller, natural-looking eyelids that harmonise with the overall face shape, avoiding the long-term “hollowed” or overly operated appearance.

What Can Eyebag Surgery Do For Me?

01. Release of Tear Trough (TT) Ligament

Releasing the tear trough ligament allows the fat to flow towards the cheeks, helping to reduce the risk of recurrence of eyebags.

02. Contouring of Eyebag Fat

New techniques focus on eyelid shaping and periorbial contouring, blending the lid-cheek junction. Traditional methods that emphasise extensive fat removal are no longer commonly used.

03. Tightening Excess Skin and Bulging Muscle

Current approaches prioritise muscle preservation and re-suspension, which can lower the risk of complications compared to older methods involving extensive muscle resection.

Benefits of Preservation Eyebag Surgery

No Visible Scars

In cases where there is no or minimal excess skin, the incision is made inside the lower eyelid, ensuring there are no visible external scars. This short, 1-1.5cm transconjunctival incision remains discreet, preserving the natural appearance of the under-eye area.

In certain cases, where there is excess lower eyelid skin, pre-existing eyelid malposition or when patients desire a mid-cheek lift, a skin excision with lower mid-cheek lift can be performed. (See below)

Preservation of Eyebags

Unlike traditional techniques that remove fat, this method preserves the fat and addresses the issue with the tear trough ligament. By releasing the ligament, fat can be repositioned to fill hollows, reducing the risk of future hollowing under the eyes.

Shorter Surgery Time

The technique is efficient, reducing the amount of time spent under anaesthesia and minimising overall downtime.

Reduced Risk of Complications

By preserving the natural structure of the eye area, the procedure lowers the risk of post-surgical complications such as ectropion, which is common in traditional surgeries.

Faster Recovery

Minimal trauma to surrounding tissues allows for faster healing and allows patients to return to normal activities sooner.

Tolerable Under Local Anaesthesia

The procedure is typically well-tolerated under local anaesthesia, with many patients finding it comfortable. IV sedation is also an option but is usually not necessary.

Techniques Used in Preservation Eyebag Surgery

Preservation eyebag surgery is typically performed using one of two main techniques: the transconjunctival or subciliary approach. Both approaches may incorporate additional manoeuvres such as tear-trough ligament release and fat preservation or repositioning, depending on the individual’s anatomy and needs.

Transconjunctival Approach
Preservation (Scarless) Eyebag Surgery

This method involves an incision made on the inside of the lower eyelid, leaving no external scar. It is commonly used when there is minimal excess skin and allows access for contouring the fat pads without disrupting the outer skin.

Within this approach, the tear-trough ligament may be released to improve the transition between the lower eyelid and the cheek. Fat is often preserved and repositioned to smooth out hollowness and enhance the under-eye contour.

Subciliary Approach
Preservation (Scarless) Eyebag Surgery

The subciliary approach involves a small incision just below the lower lash line. This method is chosen when there is excess skin, muscle laxity, or more pronounced fat bulging.

Like the transconjunctival approach, it may also involve tear-trough ligament release and fat preservation or repositioning. In addition, skin and muscle can be excised as needed to refine the lower eyelid contour. The scar is usually well-hidden and tends to fade over time.

Combination With Other Procedures

Preservation eyebag surgery can be effectively combined with other cosmetic procedures, such as facial fat grafting or upper eyelid surgery, to achieve a more comprehensive rejuvenation. This approach not only addresses the specific concerns of under-eye bags but also enhances overall facial harmony.

Considering Eyebag Surgery?

Book a personal consultation with Dr. Terence Goh to discuss your options.

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Preparing for the Procedure

Consultation

A thorough evaluation of the under-eye area is conducted, including fat distribution and the condition of the tear-trough ligament. This thorough assessment helps create a personalised surgical plan tailored to the patient’s specific needs and desired outcome. A key in this discussion is whether you would need skin excision.

Medical Review

A comprehensive medical review will be conducted to ensure the patient is in good health and suitable for surgery. This includes discussing any existing medical conditions, allergies, or medications that could affect the surgery or recovery process. One of the most significant risks in eye surgery is bleeding, so we must ensure that patients are not taking any medications or supplements that increase their risk. Patients who are hypertensive would need to ensure that their blood pressure is well controlled.

Pre-Surgical Guidelines

To ensure optimal recovery and minimise complications, stop smoking two weeks before surgery and avoid alcohol, aspirin, non-steroidal anti-inflammatory drugs, blood thinners, and supplements one week prior. Discontinue contact lens use three days before, and on the day of surgery, remove all eye makeup, false lashes, glue, or eyelid tape.

Step-by-Step Process

1. Anaesthesia

Local anaesthesia is administered prior to the procedure to ensure your comfort. While the initial injection may cause slight discomfort, the area will quickly become numb. Any mild discomfort at the injection site is brief and subsides quickly, allowing you to remain relaxed throughout the procedure. Light sedation can be requested if patients have a preference.

2. Incision Placement

A small transconjunctival incision is made inside the lower eyelid, avoiding any visible scars on the outer skin.

3. Fat Repositioning and Tear-Trough Ligament Release

The fat beneath the eyes is carefully redistributed to smooth hollows and enhance the lid-cheek transition. Simultaneously, the tear-trough ligament is released, improving the contour and reducing the shadowing under the eyes.

4. Closure of the Incision

The incision is small and two absorbable sutures are used for closure, promoting a smoother recovery process.

Post-Surgical Care and Recovery

A structured recovery programme is necessary to optimise healing and ensure the best possible results after preservation eyebag surgery.

Initial Recovery

Patients may experience soreness, tightness, and swelling, with maximum swelling typically occurring 48 to 72 hours post-surgery. Cold compresses should be applied every hour during the first 48 hours to minimise swelling. Clean the eyelids gently with gauze and sterile saline three times daily. Pain relievers should be taken as prescribed to manage discomfort.

Activity Restrictions

To ensure proper recovery, refrain from smoking, alcohol consumption, strenuous exercise, and upper eyelid makeup for at least 2 weeks. Avoid eye or facial massages and any activity that could put pressure on the eyes during this period.

What To Expect?

Day 1-3

Peak swelling occurs on day 3 post-surgery, after which gradual improvement begins.

Day 5-7

A follow-up appointment will be scheduled for suture removal. Most patients experience sufficient reduction in swelling and bruising to comfortably return to work and engage in limited social activities.

Day 14

Although some minimal residual swelling may still be present, the surgical intervention will generally no longer be visible to others at this stage.

Month 2-3

Final aesthetic results become fully visible, revealing a natural, rejuvenated appearance.

Frequently Asked Questions (FAQ)

Am I a candidate for this surgery if I have previously undergone eyebag surgery?

Yes, preservation eyebag surgery can often address residual or recurrent issues from previous procedures. A thorough consultation will assess your needs and determine if the procedure is suitable for you.

Can this procedure help with dark circles under the eyes?

The surgery can reduce the shadowing caused by structural issues such as fat herniation or skin laxity. However, it does not directly treat pigmentation-related dark circles. For that, nano-fat grafting may help.

How long do the results of preservation eyebag surgery last?

The results of this surgery are typically long-lasting, especially with proper skincare and a healthy lifestyle. However, the natural ageing process will continue, and some changes may occur over time.

Can I undergo this surgery if I have dry eyes or other eye conditions?

A comprehensive eye health assessment will be conducted to evaluate whether you are a suitable candidate for the procedure. Certain eye conditions may require special consideration or additional treatments.

What happens if I experience complications like asymmetry after surgery?

In rare cases, minor corrective procedures may be performed to address any concerns, like asymmetry. Follow-up consultations are scheduled to ensure the best possible outcome after surgery.

What are the potential risks and complications?

Complications, while uncommon, may include bleeding, infection, and mild asymmetry. Excessive bleeding may require intervention, and infections may need antibiotics, eye drops, or additional surgery. Temporary functional issues, such as dry eyes or incomplete eye closure, as well as rare risks like eye injury, allergic reactions, or anaesthesia complications, are also possible.

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Dr Terence Goh

Choosing to combine the intricate skills of microsurgery with aesthetic surgery, Dr Goh specialises in gynaecomastia, surgery of the Asian face, particularly Asian eyelid surgery and rhinoplasty.

Blending the precision of microsurgery with the artistry of aesthetic surgery, Dr Goh has a special interest in gynaecomastia, facial procedures, including ptosis and eyelid surgery, as well as rhinoplasty.

He also offers a full range of body contouring procedures such as mummy makeovers, breast augmentation, liposuction, and body sculpting—designed to help patients feel more confident and comfortable in their own skin.

Beyond aesthetics, Dr Goh remains active in reconstructive microsurgery, with expertise in breast reconstruction, head and neck reconstruction, and lower limb salvage—restoring both form and function where it’s needed most.

  • Bachelor of Medicine, Bachelor of Surgery, National University of Singapore
  • Master of Medicine, National University of Singapore
  • Member of the Royal College of Surgeons
  • Fellow of the Academy of Medicine, Singapore (Plastic Surgery)
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