I Am 20 and Have Enormous Puffy Bags Under my Eyes. What Kind of Surgery Should I Get?

I am only 20 and I have always had horrible dark circles under my eyes. Since 18 I noticed that the dark circles were turning into bags and they are only getting worse, rounder and fattier.My mums family all have horrible big fatty sacks under their eyes. Everybody thinks I am tired when im not and lately I honestly feel like I could pass for 35. I also have bad allergies which make them a lot worse. I am depressed and I just want to look my age. Please help me.

Doctor Answers 23

Conservative Eyelid Surgery

It is not unusual to see this type of "puffiness" at your age. The most effective way to resolve your problem is to have a transconjunctival lower blepharoplasty. It is critical that your surgeon be very conservative with fat removal because you could appear hollowed out if too much is taken. It is better to surgically under-treat than over-treat your problem. I hope you find this helpful.


New York Oculoplastic Surgeon
5.0 out of 5 stars 124 reviews

Under eye bags - There are several options

Based on your photos, it appears you some herniation of the fat in the lower part of your eye socket.  You may get some improvement with facial fillers, but a lower eyelid blepharoplasty with fat transposition done from an incision on the inside of the eyelid will be the longest lasting option. It will release the tissue holding back the fat so it can move into the groove between the eyelid and cheek.  This restores the youthful look of the lower eyelid.  

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Bags under the eyes at 20

If they are truly enormous at age 20, then this is a hereditary problem and you may have undeveloped bony structure under the lower lids, called the infraorbital rims. The bags, which are pseudo-herniated fat pads can be reduced through an incision inside of the lower lids, and it may be necessary to insert a silicone implant as well. This is very successful in the right patient done by someone who is experienced in the procedure. The implants must be tailored to the patient.

Alternative treatments, much more temporary, would be filling the depression under the bags with a filler or fat grafts. Correcting deficiencies in this area can be extremely satisfying for the patient and doctor. Both reducing the fat "bags" and the implant are permanent, but the trial with the fillers is a good idea to see if this is satisfactory for you. If it is,then athemore permanent solutions mentioned above can be performed.

E. Ronald Finger, MD
Savannah Plastic Surgeon
4.8 out of 5 stars 75 reviews

Puffy bags in 20 year old

  Yes, you DO have puffy bags which could be treated surgically.  But surgery is not always the right answer and some times there are complications.   I think it would be most prudent for you to consider an under eye filler for now.  This may give you the results you are seeking and successfully delay surgery for years.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 123 reviews

Eye Bags, Circles, and Demarcations

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  Most people have a multifactorial problem meaning they have more than one issue causing this demarcation. Below is a list of common issues and my treatment protocols. 

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Under Bag Treatment

Thank you for your question Georgia, due to your age you may want to firstly go down the route of having fillers which is temporary solution.  The most effective option would be transconjunctional lower blepharoplasty, which can be performed under twilight sedation or general anaesthetic.  Please seek out a board certified oculoplastic surgeon in your area, so they ca assess your eyes and advice.

All The Best! 

Amir Nakhdjevani, MBBS, MRCS, FRCS (Plast)
London Plastic Surgeon
5.0 out of 5 stars 68 reviews

What to do for puffy lower eyelid bags in a 20 year old?

Lower Eyelid Bags can be caused by many different issues. Sometimes a combination of issues are contributing to the dark, heavy look of the lower lids. Changes in skin, fluid accumulation, muscle, fat from the eye socket, and changes in the cheek and surrounding structures can all contribute. It is important to have an experienced physician evaluate your eyelids to determine all the changes that need to be addressed to achieve your goals. At your age, I am very hesitant to recommend surgery. As described before, transconjunctival blepharoplasty with fat transposition may be an good option. However, in many cases, in office procedures can be used to improved the shadowing and baggy appearance of the lid. I commonly use injections such as Restylane, and Voluma in combination with skin rejuvenation to improve the lower eyelids without surgery.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Minimally Invasive Blepharoplasty is an option

Thank you for your photographs.  You are of course, fairly young and I do see the area of concern regarding excess bags of your eyes. It would certainly be possible to perform a minimally invasive eyelid rejuvenation procedure.this wouldn't have an incision on the inside of the eyelid in an effort to smooth and contour of fat. Your deformity is caused by a membrane of the lower eyelid the orbital septum.  This structure can often be re- positioned in an effort to improve the overall appearance of the lower eyelid. Its important to find a board certified plastic surgeon with experience in rejuvenation of the lower eyelids in young patients.  This can certainly be a very big improvement .  Best of luck, Dr. Pacella

Salvatore Pacella, MD, MBA, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 33 reviews

Puffy lower eyelids

From your picture it looks like your condition is congenital ( I bet your relatives have a similar amount of puffiness) and not likely to get significantly better with conservative approaches such as fillers, peels, etc. You look to be a good candidate for lower eyelid blepharoplasty, probably through a transconjuctival approach ( inside the eyelid)

G. Wesley Price, MD
Chevy Chase Plastic Surgeon
4.7 out of 5 stars 7 reviews

I Am 20 and Have Enormous Puffy Bags Under my Eyes. What Kind of Surgery Should I Get?

 You have significant loss of the volume of the orbital rim ( eye socket rim) and associated with pseudo herniation of the fat.

Ideal solution would be 
1. Surgical removal of fat by the transconjunctival route and the amount of fat excised is minimal.
2. You need to add volume to 'build up' your deficient eye socket rim. It can be done with an Implant or with Fillers.

It may be a good idea to try the non surgical approach with Fillers first followed by the Surgical options depending on the results.

Naveen Somia, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 72 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.