Under-Eye Bags

As we age, it’s common to develop mild swelling or puffiness that creates under-eye bags. Thankfully, in-office treatments and topical skin care can reduce their appearance. Here, we break down all the best prevention tips and treatment options to get rid of eye bags.

As we age, it’s common to develop mild swelling or puffiness that creates under-eye bags. Thankfully, in-office treatments and topical skin care can reduce their appearance. Here, we break down all the best prevention tips and treatment options to get rid of eye bags.

Medically reviewed by Mathew A. Plant, MD, FRCSCCertified Plastic Surgeon
Written byKaryn RepinskiUpdated on July 2, 2021
RealSelf ensures that an experienced doctor who is trained and certified to safely perform this procedure has reviewed this information for medical accuracy.You can trust RealSelf content to be unbiased and medically accurate. Learn more about our content standards.
Under Eye Bags 754x484
Under Eye Bags 754x484

Puffiness, swelling, and dark circles can contribute to the appearance of under-eye bags. While this happens more commonly as you get older, people of any age can experience bags under their eyes.

It’s rare for under-eye bags to indicate a medical issue, so this concern is typically only cosmetic. Luckily, you can treat them with both temporary, at-home solutions and longer term, in-office treatments.

Muscles and tissues around the eye gradually weaken as we age, and the fat that naturally supports the eyes can push forward or sink, making lower eyelids look puffy and swollen. The herniation (or protrusion) of these fat pads can also create or worsen the appearance of the tear troughs, which are the creases that run from the inside corner of the eye to the upper cheek. 

Excess fluid can also collect in the space below your eyes, further stretching the skin and making the lower lids look even puffier. According to the Mayo Clinic, salty foods, allergies, lack of sleep, and smoking are all common causes of under-eye fluid retention. Swelling can also cast shadows under the eyes. 

A tendency to develop prominent bags under your eyes can also be inherited and appear at an early age. One RealSelf member says her genetic eye bags have made her look tired since she was 10 years old. 

The severity of under-eye bags can change from day to day, a phenomenon that becomes more noticeable over time, says Dr. Christopher Hess, a plastic surgeon in Fairfax, Virginia.

RealSelf Tip: A doctor who’s an expert in eyelid aesthetics can determine whether you have eye bags or “festoons,” which are often confused for one another. According to Dr. Cameron Chesnut, a dermatologic surgeon in Spokane, Washington, “festoons sit below the eyelid but actually encompass the upper part of the cheek.” He notes that “there are different kinds of festoons, and the management of them differs, based on the underlying cause. Treatments vary from medications bought over the counter to in-office injection, laser resurfacing, and surgery.”

Related: Waking Up Tired Eyes: What Really Goes Into an Eyelid Lift

There are both surgical and nonsurgical options for treating under-eye bags. The severity and cause of your bags will determine the best one for you, so finding an experienced doctor is key.

Doctors and RealSelf members say these treatments are the most effective at removing or reducing the appearance of eye bags.

Dermal Fillers (Page Image)Dermal Fillers

nonsurgical

Worth It Rating90%86%92%85%
Average Cost$1300$2125$4950$5000
DowntimeMinimal or no downtime1–12 days of downtime (depending on intensity)1–2 weeks of downtime1 week of downtime
AnesthesiaTopical or no anesthesiaTopical anesthesiaLocal anesthesiaLocal anesthesia
  • Injectable fillers “use volume to disguise under-eye contour irregularities,” says Dr. Camille Cash, a Houston-based plastic surgeon. Results are immediate, but they’re also temporary, lasting up to a year. Fillers don’t actually reduce puffiness; they fill in hollows below the fat pad so that the lower eyelid blends into the cheek. Besides hiding mild eye bags, fillers can lighten shadows.  Injectable fillers have yet to be FDA-approved for use under the eyes, but they’re commonly used off label. Just make sure to find a provider who’s intimately familiar with facial anatomy and frequently performs under-eye injections.  This quick in-office procedure is usually performed using a blunt-tipped cannula, which helps reduce bruising and discomfort.  “If you’re reluctant to commit to surgery, fillers alone would likely give you a reasonable improvement, but they won’t completely obscure the protrusion of fat,” says Dr. Jill Foster, an oculoplastic surgeon in Columbus, Ohio. Thinner fillers, like hyaluronic acid–based Restylane Silk, Belotero, and Volbella, tend to work best in the delicate eye area. They’re less likely to cause lumps and bumps and don’t have a strong tendency to hold on to moisture, so they’re less likely to cause dramatic swelling—more puffiness is the last thing you need when treating under-eye bags. A major upside to using hyaluronic acid fillers is that they can be dissolved with an enzyme (hyaluronidase) if you don’t like the results or have a complication.  Bruising is an expected side effect. It typically resolves within two weeks and can be covered with makeup in the meantime. Using cold packs immediately before and after the procedure can help minimize bruising.  There’s also a risk of a bluish discoloration, called the Tyndall effect (except with Belotero, which isn’t associated with this risk)—and even a remote possibility of blindness, if the filler is accidentally injected into a blood vessel. Learn more about the potential pitfalls of under-eye fillers. Find doctors who offer injectable fillers
  • Laser resurfacing uses the heat from laser energy to remove the outer layers of skin and promote new cell turnover. This can reduce wrinkles in the targeted area—in this case, the under-eyes—and firm skin.  Ablative lasers remove the surface layers of the skin, creating the most significant improvement—with more downtime. Non-ablative lasers have a shorter recovery time but may require multiple sessions in order to achieve your desired results.  Both options trigger the skin’s healing process, which stimulates collagen production. This new collagen helps to tighten the tissue and improve the overall under-eye area.  Find doctors who offer laser resurfacing
  • Eyelid surgery (aka lower blepharoplasty) is an extremely effective way to permanently get rid of eye bags. If you have excess skin and fat that need to be removed or repositioned, the procedure can create a smoother, firmer contour underneath the eye.  It's often performed under local anesthesia, and incisions are placed just below the lash line, to camouflage them. Recovery generally takes a week or two. Related: How Much Eyelid Surgery Costs and Whether It’s Worth It, According to 6 Women Who Got the Procedure The fat can also be repositioned into the tear trough area rather than removed, via an incision on the inside of the eyelid—a scarless approach many surgeons now prefer. “We tend to lose facial fat as we age, so taking fat out as part of a surgical procedure may look good immediately, but it is a bad idea in the long-term,” says Dr. Cameron Chesnut, a dermatologist in Spokane, Washington. Removing too much fat can create hollowed-out lower lids, while repositioning it using this approach allows the surgeon to avoid disrupting the delicate muscles and ligaments necessary for lower-eyelid support. A transconjunctival technique, which doesn’t require any stitches and comes with about a week of downtime, addresses only fat pockets. Lax skin and textural issues, like lines and wrinkles, can be treated with lasers, peels, or microneedling at the same time, if desired, or even an additional incision. “In cases where there is excess fat needing to be repositioned as well as excess skin needing removal, many surgeons are moving toward a dual-incision approach,” explains Dr. Mathew Plant, a plastic surgeon in Toronto. “With this technique, the fat is addressed with a transconjunctival incision and then the skin is removed with a lash-line incision.” According to Dr. Plant, this technique is gaining popularity because it preserves the delicate supporting structures of the lower eyelid that sit in between the skin and fat, decreasing the risk of certain complications. While a lower blepharoplasty is an effective option for improving under-eye bags, there are risks, according to the Cleveland Clinic. For instance, surgery that’s too aggressive can actually cause more sagging of the lower eyelids. This can result in a “sad” appearance and may also cause discomfort. To avoid potential complications, be sure to choose a board-certified surgeon with extensive experience in the procedure. Find doctors that offer eyelid surgery
  • Facial fat transfer can offer more long-lasting, natural-looking results than fillers do. This minimally invasive surgical procedure is performed in less than an hour, under local anesthetic, with minimal pain and swelling afterward.  The fat is commonly placed via small “microinjections,” to gradually build a new soft-tissue structure and encourage new blood vessels to grow into the grafted fat. While not all transferred fat survives, the 50—60% that typically does should be permanent.  The downside of fat is that it can be more unpredictable than fillers, says Dr. Jonathan Kulbersch, a facial plastic surgeon in Charlotte, North Carolina. And if performed poorly, this method may create lumps that can be very hard to correct in thin under-eye skin.   Fat grafting is a two-step procedure that begins with excess fat being harvested from elsewhere on the body via liposuction. “We have to not only harvest good-quality fat from other areas of the body, we have to make sure it continues to stay of good quality during the transfer,” says Pittsburgh plastic surgeon Dr. James Fernau. “Then we have to properly inject it—and even the most experienced doctors have trouble doing this, just because fat grafting under the eye is so unpredictable.”  It can be a good strategy to have temporary fillers first, to be sure you like the effect. Then, if you want a longer-lasting correction, choose a fat transfer provider “who has an immense amount of experience and talent,” suggests San Francisco plastic surgeon Dr. Mats Hagström. When done correctly, it’s a great procedure, he says. But “I see too many people posting on RealSelf, asking how previously grafted fat in the face can be removed.” Find a doctor who offers facial fat transfer

Related: The Ultimate Guide to Bigger, Brighter Looking Eyes—From Makeup to Medical Treatments

Eye creams can’t work miracles, but don’t discount the value of a good product in helping to minimize puffiness. “Skin in the periorbital area is the thinnest of the face, which makes it more prone to premature aging,” writes Dr. Nissan Pilest, a dermatologic surgeon in Irvine, California, in a RealSelf Q&A. When it comes to the best eye cream for bags, he recommends a formula that contains ingredients like retinol (a chemical cousin of Retin-A and Renova) and peptides, to boost collagen production and thicken under-eye skin. 

Caffeine, which is found in products like the BeautyStat Universal C Eye Perfector, is another popular eye cream ingredient because it constricts blood vessels in order to reduce puffiness and redness. 

If dark circles are also a concern—puffiness and dark under-eyes often go hand in hand—but you're not ready to try dermal fillers, skin-care products with ingredients like vitamin C, arbutin, kojic acid, licorice, and niacinamide (a form of vitamin B) can help brighten the area. 

Related: 15 Concealers Almost as Good as Under-Eye Filler

Thankfully, you don’t have to spend a lot of money to get an effective eye cream. Beverly Hills, California, oculoplastic surgeon Dr. Kenneth Steinsapir recommends looking in your drugstore. “There really is not much difference between a $30 eye cream and a $300 eye cream besides fragrance, packaging, and a whole bunch of marketing money."

Some home remedies can help get rid of eye bags instantly (or at least de-puff them). Start by applying cold compresses or chilled cucumber slices. The coolness can constrict blood vessels that leak fluid, temporarily improving the appearance of puffy eyes. Cool, wet caffeinated tea bags can have a similar anti-inflammatory effect.

Hemorrhoid cream does often contain an ingredient (phenylephrine) that constricts blood vessels, but if you accidentally get it in your eyes, you may experience a severe inflammatory response. If you choose this product, apply it very carefully.

Updated July 2, 2021

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