How do I get rid of eye bags?

Eye bags are caused by fat accumulation in three little compartments in the lower lids and two in the upper lids. This is diet-resistant fat, which means it is not related to weight gain or loss.

Fat pads in the lower lids are removed through an incision on the inside of the lower lids and through an incision along the crease of the upper lids. Fat is not removed with liposuction but by teasing it out and cauterizing it to make sure it does not bleed.

This is a complicated problem with many solutions, none of which are perfect in isolation.

Three main problems that cause eye bags:

1. Fullness caused by "pseudoherniation" (bulging) of normal orbital fat that surrounds and protects the eyeball or just below this area, a relative hollow that develops and is aggravated by gravitational descent of cheek fat
2. Loose skin and muscle surrounding from age, heredity and environmental factors (smoking)
3. Pigmentary issues related to dark discoloration with thin skin and prominent blood vessels compounded by a shadowing effect due to the contour issues (1. and 2.) listed above.

Surgical treatments include:

• Carefully remove or reposition orbital fat
• Reposition/lift cheek fat and tissues
• Reposition/tighten eyelid skin and muscle
• Fill orbital contour hollows with fat injections

Non-surgical treatments include:

• Skin care with peels
• Anti-pigment treatments
• Intense pulse light and non-ablative laser treatments for vascular pigment and skin tightening
• Soft tissue filler enhancement for hollows

Although this is most often treated with surgery (called a blepharoplasty), no two cases are identical and for some a nonsurgical option may be worthwhile.

The bags are bulging fat, normally held back in the eye socket. The shadow created along the "tear trough" is what contributes to the problem.

Most surgeons remove the bags by taking out the fat, but as we get older we lose fat around the eyes and so it may actually accelerate the aging process in the end. Better to reposition the fat into the tear trough rather than remove it in many cases.

For milder cases, a filler into the tear trough such as Restylane, Perlane, or Juvederm often works very well.