1. What is pouch?

With the growth of age and the continuous effect of the earth's gravity, the lower eyelid skin relaxes, the orbital septum supporting force decreases and then prolapses, and the tension of the orbicularis oculi muscle decreases, then a pocket shaped expansion is formed above the lower edge of the orbit, and the cheek eyelid groove is deepened, which is called the pouch.

Lower eyelid pouch is closely related to human aging and facial tissue aging, while some young people's pouch is related to family genetic factors.

2. Clinical classification of lower eyelid pouch

Slight pouch: the lower eyelid skin, orbicularis oculi muscle, and orbital septum are slightly relaxed when sitting flat, the orbital fat slightly bulges forward but is not obvious, and the pouch bulge area is limited to above the lower edge of the orbital bone. Most of the bags under the eyes of young people are mild.

Moderate pouch: when sitting flat, the lower eyelid skin, orbicularis oculi muscle, and orbital septum are obviously loose and drooping, and the orbital fat is obviously raised and displaced forward and downward. The pouch bulge area is obvious at the lower edge of the orbital bone, and is often accompanied by obvious arc-shaped grooves such as crow's feet. This type of * is commonly seen in patients requiring cosmetic surgery clinically.

Severe pouch: when sitting flat, the lower eyelid skin, orbicularis oculi muscle and orbital septum can be seen to be obviously prolapsed in a pocket shape. The pouch bulge area is large, mainly located below the lower edge of the orbital bone, affecting the cheek and face. The face is obviously aging and wrinkled, often accompanied by the droop of the eyebrow and lateral canthus angle, showing a unique triangular eye shape.

3. Selection of pouch removal surgery

The pouch will become more and more obvious with the growth of age. At this time, only by removing the fat protruding from the orbital septum through plastic surgery can the smooth lower eyelid be recovered.

At present, there are two kinds of lower eyelid blepharoplasty: transdermal incision (external incision) and transconjunctival incision (no trace). So, how should we choose our own surgical method?

Removal of pouch by external incision

The external incision pouch plastic surgery is to cut along the lower edge of the lower eyelid eyelashes to the outer canthal groove, remove the bulged pouch fat, and at the same time, remove the redundant lower eyelid skin to remove wrinkles. This method is suitable for solving the problem of lower eyelid pouch with skin laxity and orbital fat prolapse, especially for removing moderate and severe pouch.

Advantages: It can simultaneously treat skin, orbicularis oculi muscle, orbital septum and orbital fat, with wide indications and reliable postoperative effect.

Disadvantages: The amount of skin resection is required to be moderate, there is more bleeding during the operation, and there is scar left after the operation.

Traceless pouch removal

The incision of the trackless pouch removal operation is located in the conjunctiva, and a small incision is made at the eyelid conjunctiva to remove the excess fat. It is mainly suitable for people with simple orbital septum fat bulge and good elasticity of the lower eyelid skin, but not for moderate and severe eye bags with obvious relaxation of the skin, orbicularis oculi muscle, and orbital septum.

Advantages: less tissue damage, less bleeding, no skin incision, no exposed scar after surgery, and no complications such as eyelid ectropion, epiphora, incomplete closure, lower eyelid retraction, etc.

Disadvantages: The skin, orbicularis oculi muscle and orbital septum cannot be treated at the same time, and the scope of indications is small.

4. Postoperative effect of lower eyelid pouch

The effect of lower eyelid blepharoplasty is not as immediate as that of double eyelid surgery, especially for mild and moderate blepharoplasty. It is generally believed that the ideal effect should be: the double lower eyelid pouch disappears or is not obvious after the operation, the local area is flat, the skin wrinkles and relaxation are reduced, the incision scar is not obvious, and there is no complication that cannot be recovered by itself.

5. Eye pouch surgery also has risks

Like any plastic surgery, pouch surgery also has the risk of complications.

(1) Eyelid ectropion: manifested in bulbar eyelid detachment, accompanied by overflow of tears, lower eyelid displacement, rounded outer canthus angle, and frightened eyes. Slight ectropion will recover after several months of comprehensive treatment.

(2) Lower eyelid depression: it is caused by excessive excision of orbital fat. If the depression is obvious, fat transplantation by injection can be used.

(3) Incision scar exposure or hyperplasia: the suture alignment is uneven, and the suture is too thick; Too much skin resection and great tension during suture; Postoperative incision infection; Scar constitution.

(4) Eyelashes fall off and are incorrectly arranged: the incision is close to the lower eyelid eyelashes, damaging the root of eyelashes; When sewing, the suture needle damages the root of eyelashes.

TIPS： Precautions for removing eye bags

1. After pouch surgery, some people may still have slight pouch, because it is impossible to completely remove the pouch.

2. There may be slight ectropion of the lower eyelid margin after the pouch removal operation, which can be repaired by itself generally.

3. After the pouch removal surgery, generally no scar will be left, but the lateral canthus incision will leave traces, which will disappear after 6-12 months.

4. Some patients may suffer from photophobia, tears, blurred vision, decreased vision, or even diplopia, and generally recover within 6 months.