Bags under the eyes have been shown to be caused by the relaxing of the support tissue around the eyes accompanying aging. So if there are bags under the eyes, it is recognized by others as a typical sign of aging and causes a serious inferiority complex in the individual. Conventionally this problem was generally addressed by removing skin from directly underneath the lower eyelid eyelashes. But cutting away skin poses the risk of aftereffects, such as leaving a mark (scar) and excessive removal of the skin can cause the lower eyelid to turn outward (the so-called "bleah insult" look). This is the reason that lower eyelid skin removal surgery is said to be one of the most difficult of the aesthetic plastic surgeries.
Until recently the treatment for bags under the eyes involved the above risk, so many people were hesitant to receive the procedure even though this problem bothered them. Seeing this, Dr. Kubo of Ginza CUVO began looking for a way to solve this problem without cutting the skin. At the beginning of 2000, Dr. Kubo was trained in America in the superior method of using a laser from the back side of the eye (conjunctiva) without cutting the skin. At the time, the treatment for bags under the eyes performed from the back side of the eye was only used on young people. Dr. Kubo, however, began improving on the method he learned in America to develop the innovative method of not only removing the deviant fat, which is the main cause of bags under the eyes, but also lifting the lower eyelid skin without cutting it. This makes it possible to remove the bags under the eyes of not only young people, but even relatively elderly people in their 60's and 70's without cutting the skin.

Overview

There is a very delicate structure around the eyelids that responds to the fine movements of the eyes. The eyeball support tissue is also delicate, and the relaxing of this support tissue with aging causes the lower eyelid fat tissue to project forward. Asians have a lot of lower eyelid fat tissue and the bags under the eyes with aging becomes very pronounced. For this reason, treating the very delicate lower eyelid structure requires specialized skill acquired through much experience.
From the time Ginza CUVO opened until today (as of October 2011), Dr. Kubo has handled over 6,000 cases by conducting all of the counseling, procedures, and follow-up himself. The result of this extensive treatment experience is Dr. Kubo being one of the few physicians that can safely and surely perform lower eyelid surgery, which is said to be one of the most difficult procedures in the field of aesthetic plastic surgery. This is one of the major distinguishing features of the Ginza CUVO. Following are some typical cases of treatment for bags under the eyes from when the clinic first opened in 2005. Some of the clients had received counseling for bags under their eyes from other clinics.
Patient: "I'm interested in the method that treats dark circles and bags under the eyes from the back of the eye without cutting the skin, but what do you think?"
Other clinic doctor: "Using that method the symptom will return in a few years and it might cause wrinkling or sinking in the skin, so I don't think you should do it. I think removing skin from the lower eyelid is the better way to treat bags under the eyes. Let's use that method."
Patient: "Is that so. I don't know if I want to go so far as cutting the skin... I want to think about it some more." Later, the patient wanted to know the truth about treating bags under the eyes from the back of the eye and so went to the Ginza CUVO Clinic for an examination.
Patient: "I was told by another clinic that treatment from the back of the eye won't solve the problem." Dr. Kubo: "There is a high probability of the problem being solved using that method."
Patient: "I was told that even if I received the treatment, the problem would return in a few years and could cause wrinkles and sinking."
Dr. Kubo: "Did you ask that doctor how many cases he had treated using that method?"
Patient: "No."
Dr. Kubo: "Did he show you any treatment case photographs?"
Patient: "The doctor told me he didn't have any photographs he could show me."
Dr. Kubo: "I see. Well, now I'm going to give you a detailed explanation regarding this case."My impression is that the doctor of the other clinic had little experience treating bags under the eyes from the back of the eye. This doctor was probably only using the method of removing skin from the lower eyelid to treat bags under the eyes. I get one or two model patients from every 100 treatments I perform. So when a patient asks me to show them some case photographs, I can show them case photographs of the type that resembles the patient's type. Not having many model patients is a sign of having little treatment experience.
This doctor's comment that "Treatment from the back of the eye will not solve the problem and could cause wrinkling and sinking" was probably due to his lack of experience and is not necessarily true. So does the problem really return and wrinkles and sinking occur when going from the back of the eye to remove the fat? Of course, there is the possibility of those things happening if the procedure is performed by an inexperienced doctor. There is very little chance of them occurring, however, when the procedure is performed by an experienced doctor.
Finally, will the problem really return after treatment from the back of the eye? I will answer this question. Removing the lower eyelid fat that is protruding forward (about 60% of the fat present) and laser treating the cut area will prevent reoccurrence. An analysis of cases from the past 7 years showed that for cases where the procedure was performed correctly, the problem does not return even after many years have passed.

Does treatment of bags under the eyes cause wrinkles or hollowing under the eyes?

Look at the illustration on the right (front view).
The lower eyelid fat is formed of 3 bunches of fat. Wrinkles or sinking could occur when the treatment is performed by an inexperienced doctor when the fat is not unevenly removed from (1), (2), and (3). When the treatment is actually performed, the fat is easiest to remove from (2), so an inexperienced doctor will tend to only remove the fat from (2).

Look at the illustration on the right (cross-section view).
In this case, it is expected that sinking will occur in the middle. Because the skin is wavy, the wrinkles standout easier. Because the fat was left in (1) and (3), the problem was not completely resolved. This is exactly what the doctor of the other clinic was talking about to the patient in the above case. At Ginza CUVO, we often redo the treatment for cases where this fat has been left unremoved. So what treatment should be done?

Look at the illustration on the right. [Good Treatment]
If the doctor has the experience and skill to evenly remove the necessary amount of fat (50 to 60%) from (1), (2), and (3), the problem will not reoccur and wrinkles and sinking will not form. When the fat is correctly removed from (1), it is possible to create an attractive so-called "tear bag." Removing the outside fat of (3) first to give priority to reducing the weight applied to the inside makes it possible to just reduce the minimum amount of the fat from (3) to create a good effect without wrinkling or sinking.

Case Study