30 Years Old and Very Bad Under Eye Bags and Extremely Wrinkled Skin - What is the Best Procedure to Fix This? (photo)

I am 30 years old and genetics have blessed me with extremely thin eye skin and under eye bags, aging me beyond my years. I am most concerned with removing the excess skin/wrinkles under my eye that get much worse when I smile and also the bags. Would a fat removal or transfer help? I find it hard to smile when talking to someone face to face knowing they will see how terrible my wrinkles look. My skin elasticity is pretty bad. What can be done?

Doctor Answers (3)

Resolving your puffy eye bags permanently, and non-surgical treatments for wrinkled and thin skin

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There are a lot of options address under eye bags, but developing a good treatment strategy is very important. When people come to me for puffiness, I first teach them that if the puffiness under the eyes is always there regardless of allergies, sinuses or getting enough sleep, it is more than likely lower eyelid fat prolapse. Genetics are partly a cause. Lower eyelid fat prolapse is herniated fat that pushes forward, and regardless of the amount of sleep or any other topical treatment, it won’t change.

A very popular approach to lower eyelid surgery mostly done by general plastic surgeons is an external or transcutaneous blepharoplasty. This procedure is used when there is wrinkled skin and extra skin in the eyelids. Unfortunately, patients often end up with a widened scar on the outside and have too much skin removed. This leads to eyelids being pulled down which is called lower eyelid retraction.

In younger people, I generally do a procedure called transconjunctival blepharoplasty. This is a procedure where I go from the inside of the eyelid to address the fat pockets. There is also a combination procedure such as resecting, removing and repositioning that we perform based on the individual anatomic situation. The great thing about this approach is that there is no external incision and there is no compromise to the anatomy of the support system of the lower eyelid.

In our practice, we have a couple of different approaches that helps skin quality which are not a one-time procedures. Lower eyelid puffiness can be a one-time procedure, but skin quality generally requires ongoing care because the skin is living and always changing. What we typically do with lower eyelid blepharoplasty is an injection of platelet-rich plasma. Platelet-rich plasma is the serum of blood after it has been spun down. The serum above the red blood cell is separated is rich in platelets- the cells responsible for healing. It stimulates collagen remodeling that improves the quality of the skin and it also has something called vascular endothelial growth factors which stimulates blood flow and blood supply.

Depending in the skin, we’ll also do fractional CO2 laser or radio frequency such as Pellevé to help tighten the skin. On top of that, we will also do a steady enhancement using topical skin care products. We have our own skin care line. One of the products is called Eye Rescue and also other products with different strengths of retinols. When I designed these products, I wanted them to have good moisturizing capability and rapid cell turnover. Over-the-counter topical products are limited amount in their active ingredients by law. Fortunately, our products are dispensed under the supervision so they contain stronger active ingredients. I hope that was helpful to you, and thank you for your question.


New York Oculoplastic Surgeon
4.5 out of 5 stars 31 reviews

Lower lid bags

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Thank you for asking about the skin and fullness under your eyes.

  • Lower lid blepharoplasty - a lower lid lift with trimming the fat and tightening the skin - is the best approach,
  • Botox may help the skin and so will avoiding the sun.
  • Don't feel bad - this is a common inherited tendency and can be corrected. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.5 out of 5 stars 21 reviews

Under eye bags and wrinkles

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Radiofrequency can stimulate new collagen, dramatically improving your skin texture and wrinkles. Sublative treatments have minimal downtime and can give great results in 3 sessions.

For a more aggressive approach, ePrime can deliver radiofrequency directly to the reticular dermis. This stimulates collagen, elastin and hyaluronic acid production. The skin will look and feel healthier with just one treatment. I like to combine this with fractionated CO2 in the same treatment session. The improvement in just 3-4 weeks is amazing.

Todd C. Becker, MD, PhD
Boulder Dermatologist
5.0 out of 5 stars 4 reviews

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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.