There are basically two ways of removing eyebags. First is via an external cut (“open” technique) on the lower eyelid and the second is via a small cut made on the inner aspect (“closed” technique) of the lower eyelid which leaves no scar on the surface.
Upper and lower eyelid cosmetic procedures have been responsible for the most number of complications in plastic surgery and unfortunately, it looks like your mother had one of them.
Most likely, she underwent the traditional”open” removal of eyebag fat in which an incision is made just under the lashes to remove fat underneath.
Some skin and muscle is trimmed away to smoothen the area around the lower eyelid. Problems may start to arise here but under a highly skilled plastic surgeon, the result can be a beautiful, taut and youthful lower eyelid.
Being so delicate, it is easy for the lower eyelid to alter its shape or appearance. The cut itself, as it heals, can pull the lash line downwards thus distorting it. This usually occurs when the surgeon removes too much skin and resorts to stretching the remaining eyelid and cheek skin tightly.
In reality, the weight of the cheek drags the lower eyelid down. The eye shape becomes rounded exposing the whites of the eyeball. The lower lid may flip outwards exposing the redness of the inner aspect. Not only is this dangerous for the eyeball to slip out but it also gives off a ghastly appearance, as the eyes cannot close properly and seem to slack.
Just look at recent photos of Michael Jackson, Michael Douglas and Sly Stallone. To correct this problem, the lower lid is pulled tighter and hitched to the bony part of the eye socket or a small skin graft is inserted under the eyelashes. Either way, the eye may never look completely normal again.
Many plastic surgeons have adopted the “closed” technique where a small cut is made on the inner aspect of the lid directly into the fatty bags, which are then removed. There is no cut or damage to skin, muscles or nerves, hence no stitches. The skin heals within a matter of weeks leaving no trace of an operation. This works best in younger patients who have higher skin elasticity.
Personally, I prefer to use the “closed” technique wherever possible (and at whatever age).I use the”open” method for lower lids with clearly excessive skin or wrinkles as seen in older Asians with sun damaged skin or Caucasian eyelids which are thin with multiple fine wrinkles. Even then, I take the necessary precautions to always strengthen the lower lid by hitching it to the bony edge of the eye socket. This prevents the problems I mentioned.