23 Year Old. What Can I Do About Bags Under my Eyes? (photo)

I'm a 23 year old female. I have bags under my eyes and was wondering what my options were to get rid of them. When I smile u can see I have extra skin under my eyes and the skin is wrinkled. Attached is a picture. I look very tired when I smile and my eyes appear small. Please let me know what my options are Thank you

Doctor Answers (8)

Non-surgical treatments for your eyebags and to improve your light, thin skin

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You are concerned that your skin is loose particularly when you smile and this is certainly a common concern that a lot of people have. With the photos you submitted, I can assess that your skin is very light. People who have very light skin tend to have the skin under their eyes are almost transparent, and you can see the red quality of the muscle and the blood vessels under the eyes. If you have very light and thin skin, when you smile, the wrinkles are more obvious.

What you are experiencing is basically genetic. However, we can control the environmental factors affecting the skin. In my practice, if someone has light skin, I always advice them to protect it using sun block and moisturizers. You should do everything you can to reduce the environmental that can accelerate age-related changes. We sometimes refer to sun exposure as photo aging. Since the eyelid skin is the thinnest skin in the body, I also remind people to avoid toxins such as cigarette smoke.

There’s a subtle hint in your photo of slight puffiness under your eyes. In our practice, when someone has a slight amount of puffiness, we tend to avoid doing a surgery as the first procedure.  Instead, we give the option of a temporary procedure which helps the appearance of that slight puffiness. I suggest using a filler that is placed in the tear trough area as well as in the eyelid to cheek area to add a bit of volume and soften the transition between the two. It’s done very conservatively and in a way to minimize the chance of lumpiness. The material we typically use is something in the hyaluronic acid family called Restylane.

Another thing that we can do for patients with thin skin is to build up the collagen. We do this with a procedure called platelet-rich plasma, which draws your own blood and then we concentrate the part of the blood that has the active healing properties. It’s like getting a cut and that cut heals with the cells called platelets. In other fields of medicine, this particular technique is used to help athletes and they inject it into their joints. In the field of cosmetic surgery, we use it under the skin. We found out that we’ve been able to help a lot of our patients with this injection treatment. Often, we need to do more than one injection over the course of several months, and patients really appreciate the improvement in skin quality. In fact, a lot of our staff members avail of the same injections themselves.

I suggest that you take conservative options first, and if you notice that the puffiness under your eyes is more constant and prominent, then you may want to consider a surgical procedure. To summarize, I recommend  a filler for the tear trough area and in the eyelid cheek junction and also platelet-rich plasma to help with skin quality improvement.  I hope that was helpful, and thank you for your question.


New York Oculoplastic Surgeon
4.5 out of 5 stars 21 reviews

FIllers are your best option here.

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I personally do not believe that Boletorois the right product for this area.  I recommend Restylane.  Please find someone who does a great deal of this know their eyelid anatomy.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

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Eyelid surgery in youth

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You will do very nicely with a mid facelift to raise your demarcation line combined with a fat saving operation.  You must never have fat removed or you will be hollow in your later  years.    As  well as  the lift, a nice muscle suspension will add the extra  beauty.   Little if any skin should be removed.  It would be better to have  a peel or use a  Retin A combo for lower lids.  A laser may help also. Always best to have a nice discussion with your doc,     My    best,                DrC

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Lower lid bags

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You have apparent fat pockets in your lower lid creating puffiness in the lower lid and accentuates the crease under the eyelid towards the nose.  This is seen commonly as part of the aging process.  However, some families have these pockets at an early age.  Fillers such as Restylane or Bolertero injected into the crease can camouflage the fat but is only temporary.  You best option is a transconjunctival blepharoplasty.  This a surgery that takes 30 minutes where an incision is made inside your lower lid and the fat pockets are removed.  There are no external incisions.  Make sure you surgeon is adept at this procedure in that removing the right amount of fat and finding the right fat pockets can be tricky.

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Prolapsed fat and skin "discoloration"

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From the photo provided, we can see a couple of features:

You have mild prolapsed lower eyelid fat, and there is also a slight reddish purple hue to the skin. This is due to the very thin skin of the eyelid allowing the muscle underneath to be visible.

Unfortunately, short of concealing creams, there isn't much to be done with the color, however the transition between the between eyelids and cheek caused by the proplapsed fat can be improved. There are a couple of different ways to address this:

1. Transconjunctival blepharoplasty [surgery] to excise or, more likely, reposition your eyelid fat.       

or

2. Injectible fillers [Restylane, Boletero or Juvederm] to fill in the hollow between the eyelid and cheek. I would recommend staying away from longer acting and non reversible fillers such as Artefill and Radiesse in this region, because if you are not happy with the injection, they are not easily removed, whereas the Restylane, Juvederm, or Boletero can be easily reversed with enzyme injection.

Both surgery and fillers are effective. The surgery is a more permanent solution but is more expensive. The fillers are temporary [last 6-12 months on average, but sometimes longer] and is less expensive, but need repeat injections.

Seek an experienced surgeon/injector.

A.J. Amadi, MD
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23 Year Old. What Can I Do About Bags Under my Eyes?

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 From the photo provided, there does appear to be a small amount of lower eyelid fat however, the cheeks themselves appear quite flat.  Flat cheeks will make the face appear relative rectangular and elongated and this may be the reason that your eyes appear somewhat small.  Lower Eyelid Surgery would make the eyes appear less tired but do not have the aesthetic ability to make the face appear more feminine as Cheek Augmentation with fillers (I prefer Perlane) or Cheek Implants.  

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Bags under the eyes

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For someone your age the best and most effective treatment is the placement of facial fillers along the lower orbital rim.  This will build up a deficient area under your eyes and get rid of the shadows there.  I prefer Radiesse or Artefill; the injections should not be in the soft tissues but deep along the bony rim.  Be sure to see a Board Certified Plastic Surgeon who can show you a comprehensive portfolio of pre- and post-op pictures so you can see the types of results that you can expect.

Daniel Greenwald, MD
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.