Under Eye Bags; Fluid Retention? Fat?

I am a 28 year old male and as the picture shows, I have fairly prominent eye bags that I have been trying to find a way to correct. I went to a Dr. and she said that there not caused by fat hernation, as I had previously thought, as that seems to be the most common cause of eye bags, but some sort of fluid retention. What solutions are available for eye bags that are due to fluid retention and not fat? What might be causing this problem in the first place? Thanks for your help!

Doctor Answers 11

Treatment Plan

From the photograph, it appears you have lost substantial mid-facial tissue, but also have a slight bulging of lower fat pads. Performing a lower eyelid blepharoplasty with only a small amount of fat removal as well as placing filler in the periorbital region would most likely be the treatment of choice. It is difficult to make the accurate decision without evaluating your face in person; you should seek a consultation for an appropriate treatment plan.

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Under Eye Bags

The puffiness you are seeing is caused by fat and can be corrected with a transconjunctival blepharoplasty, a procedure that removes a small amount of fat through the inner aspect of the eyes. A fat transplant in to the adjacent outside area (tear trough) may help to even the area as well. This is done at the same time as the inner fat removal.

All the Best, 

Dr. J

A. Dean Jabs M.D., Ph.D.
Board Certified Plastic Surgeon
Bethesda MD/McLean VA

Hands on examination is necessary.

It is often obvious in a photo to determine the source of the bulginess in the eyelid. In your case, however, I feel its difficult without visualizing the skin surface, and the palpating the give of the tissues, to properly address "fat or fluid".

Although the culprit seems to mainly be lack of midface fat which exposes the orbital fat, some degree of fluid retention cannot be ruled out by this photo.

I would recommend an in person consultation with a surgeon with expertise in surgery and fillers.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 24 reviews

Eye bags are caused by a variety of things.

These are not caused by fluid retention.  What we are looking at is the bone of the orbital rim draped by the thin lower eyelid tissue.  You have a very prominent midface groove extending from the corner of the eye out to the side of the face.  What you are missing is deep facial fat in the buccal fat space that helps to support this area.  The best treatment for this is not lower eyelid surgery or midface lifting.  The best treatment is non-surgical in the form of hyaluronic acid fillers, specifically treatment with Restylane and Perlane.  The treatment will last 1-2 years provide you get enough volume.  You need to find a surgeon who does a lot of this sort of treatment.  The liquid face lift website might help you identify someone in your area who can help you with this.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 19 reviews

Under eye bags

First off, I have to say that I am a surgeon and I love doing surgery because of the beautiful results achieved with the minimally invasive transconjunctival approach. With that in mind, I would caution you to be weary of anybody who tells you that surgery is your only option. Although surgery may be the most definitive, long-lasting and quality result, there are always other options that can at least improve under eye bags.

These alternative options include fillers when there is volume loss or redistribution and descent. Fillers need to be carefully placed in this area by somebody with experience and expertise. Read: do not go to just anybody offering a deal for this type of filler.

During your consultation, your surgeon should address all of the factors contributing to your under eye bags. Fluid, muscle, and fat, whether it is too much, too little, or just being in the wrong spot, should all be addressed during this evaluation.

To guarantee you're receiving the highest level of care, seek out a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut, MD, FAAD
Spokane Dermatologic Surgeon
5.0 out of 5 stars 5 reviews

Eye Bags Treatment

Thank you for your pictures.  It does not appear that your bags are caused by anything other than fat herniation.  It is very uncommon for fluid retention to cause this.  Usually fluid retention is transient, improves with aantihistamines or diruetics.  To put your mind at ease, you should consult with an allergist.  From the pictures, I assume your issue is fat herniation.  This is treated well with a minimally invasive blepharoplasty that can be performed from inside the lower eyelid.I would get several opinions from doctors you trust.  I would suggest a consultation with a board certified plastic surgeon who specializes in eyelid surgery.  Bets of luck to you! Dr. Pacella

Lower eyelid blepharoplasty

There are many options for lower eyelid concerns, including a blepharoplasty procedure. If you have secondary allergy issues, it would be prudent to seek medical treatment for that condition. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 57 reviews

Treatment of eyelid bags

Your posted photo corroborates your concerns and show 2 bulges on each lower eyelid. The upper bulge is usually the eyelid muscle and the lower bulge is usually fat around the eyeball that herniates into the lower lid. Blepharoplasty surgery thins the muscle and removes or repositions some of the fat. Your case is not the usual because in the photo the tissues look more swollen or edematous like they are filled with water. My lower eyelids look like this when my allergies act up but that is usually accompanied by redness of the whites of the eyes and a itchy feeling of the eye and eyelids. My opinion is you should first find out if allergies are contributing to this. If they are and nasal sprays/oral claritin get rid of it then you need to keep the allergies under control. If allergy control improves the situation but does not complete resolve it then you need to be re-examined to see if fillers and/or surgery is an option.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Are my under eye bags fat or fluid retention?

I have performed eye lifts for over 20 years and lower eyelid bags are caused by:

  1. Fat tissue
  2. Malar bags

 Examination and palpation of the location of the bags will help identify the likely source of your bags.  If you press on the bags and you feel a give, in the tissue, you are inside the eye socket and the bags are most likely fat which can be reduced with a lower eye lift or eyelid surgery.  If, on the other hand, when you press on the bag you feel bone of the lower eye socket or cheek, these are what's called "malar bags."  Malar bags are caused by chronic fluid retention, or swelling and will not be reduced with eyelid surgery.

 Malar bags are caused by fluid retention and are genetic in nature.  Lowering salt content in diet can sometimes help reduce these bags.  Soft tissue fillers like Restylane, Juvederm and Perlane can help featrher the edges of the malar bags making them less obvious.  The only surgical option, that I have fould useful in eliminating malar bags is the placement of Cheek Implants, in appropriate candidates. 

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Under eyelid bags with fluid retention versus fat

 The lower lids are composed of skin, muscle, and fat. When the fatty deposits become puffy it is because of fluid retention in the  3 fat compartments. It's important to make sure there are no allergies present, thyroid conditions and at least try a low salt diet to help with fluid shift in the body. If all else fails trauma consideration for a trans-conjunctival approach through the inside of the eyelid for a conservative fat pad removal. The procedure is known as a lower blepharoplasty and takes approximately 30 minutes under a brief general anesthetic. For many examples, please see the link below  to our eyelid surgery photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

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.