Help Deciding What to Do About Under Eye Aging...are They Bags or Sunken Eyes??

asked 11 months ago by helpwitheyes in Southfield, MI
Latest answer by Guy Massry, MD
Question viewed 1,357 times
Tags: eye bags, hollow, options, sunken

I'm 31 years old. I have noticed under eye circles and puffiness. It's worse in the morning and gets somewhat better by the evening. I have tried various creams seeing minimal results. When I smile and with a lot of concealer they are not as noticable. I went to a board certified plastic surgeon yesterday and he said they are not bags, but, are hollow eyes. He suggested sculptra. I am nervous about sculptra after reading many neg reviews. Are they hollows or bags? What is safest fix?

9 answers to Help Deciding What to Do About Under Eye Aging...are They Bags or Sunken Eyes??

Eye hollows

Please be careful with Sculptra as it can lead to permanent problems. The areas around the eyes are not meant for use with this product and if complications occur they are hard to deal with. I see this often in my practice and do not have a lot to offer in terms of resolving the problem. Fat injections can work but you have a higher incidence irregularities than with reversible Hyaluronic acid fillers - the best option. Please be weary of Sculptra in this area... more

Guy Massry, MD
Los Angeles Oculoplastic Surgeon

May need some fat removal from the "bags"

Sounds like you have lower eyelid bags with a hollow area below the bags known as a "tear trough." You may need some fat removed from the "bags" and at the same time, some placed in the hollow areas.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon

Hard to say in photo

Hard to say in photo but whether its a transconjuctival fat removal for bulging fat or a tear trough requiring filler, sculptra under the eye is not ideal and agree with restylane. having said that sculptra in the upper cheek will definitely be a good choice to increase the volume and make the lid/cheek junction improve.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Fat bags of the lower eyelids

Yes, from your photos you do have fat bags in the central and medial fat pockets of the lower eyelids. These are in the early stages and are not severe but are noticable. A Transconjunctival lower Blepharoplasty (eyelid surgery) would remove these fat bags in about 30 minutes using an incision on the inside of the lower eyelid.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon

Treatment of tear troughs

Your posted photos indicate they are both. There is some protrusion of the fat pad in the lower lid near the nose on each side. There is also hollowing if the middle and outer thirds of the lower lids, seen best in the last 2 photos. I think most would agree that the current best treatment is a filler. Most doctors would agree sculptra is not the injectable of choice for this area and prefer a hyaluronate here. My response to your question/post does not represent formal medical advice or... more

Aaron Stone, MD
Los Angeles Plastic Surgeon

Lower lid bags

Fillers are probably the way to go. I would suggest something more forgiving than sculptra or fat. Restylane would likely be a good choice for this area. The hyaluronic acid fillers (like Restylane and Juvederm) are to some extent reversible if you find you don't like the effects.

Hugh McLean, MD
Mississauga Plastic Surgeon

Don't have fat or sculptra for these areas.

Visible product in the under eye area are among the most common reasons people see me in consultation. Fat grafters mean well. Perhaps they actually have a few patients who did perfect with fat grafting. However, I see so many individuals with bad fat grafting results, that I can't recommend the procedure. The reality is that the lower eyelid hollow area that needs filling is too thin and does not hide things that get lumpy very well. This is also true for... more

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon

Based on your photos, you appear to be a good candidate for a lower eyelid Injectable Filler treatment.

I read your concern and reviewed your photos. Your eyelid skin is the thinnest and most delicate, so it's typical to see more lower eyelid puffiness in the morning after being horizontal. During waking hours, gravity will pull the excessive puffiness out of your eyelids, so they will look best at the end of the day. If you have significant fluctuation in the appearance of your eyelids, you may want to bring this to the attention of your PCP to make sure you're not retaining too much... more

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon

Aging lower eyes: fat loss vs bags

Given your age (31), it is likely you had this appearance most of your life. To me, it looks like your under eyes are hollow as a result of having insufficient fat along your lower eyelid and upper cheek. This is a very common problem we see and in our practice fat transfer is what we use to treat it. The reason is, fat belongs in that area and when it is not there in sufficient quantities, the eyes look drawn and tired. In many cases, the volume loss gives the impression that... more