20 Years Old, Want Lower Bleph for Hereditary Eye Bags. What Are Best Options, Are Risks the Same at my Age? (photo)

I have had these bags since I was 12. I do not have any allergies and my thyroid is in excellent condition according to tests my doctor has done. Is 20 too young for lower bleph in my case? Since I am young, am I still as at risk for crepey/wrinkly skin in the eye area after surgery? How worried should I be about sagging lower lid/sclera show/other complications I should be concerned about? What would be the best way to remove these?

Doctor Answers 7

Treating your lower eye bags with scar-less eyelid surgery, and maintaining your youthful skin quality

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Many of my patients who are in their 30s or older will mention that they’ve had bags under their eyes since they were teenagers. It enforces the concept that this is a hereditary problem and that people have a genetic tendency to have these fat pockets under their eyes. One of my youngest patients whom we’ve operated for eye bags was actually 14-years-old. For him, the bags under his eyes were so significant that he was being teased in school that he was potentially on drugs and became very withdrawn about this aspect of his appearance.

Most likely the approach I would do for you is transconjunctival blepharoplasty. In this procedure, we are able to get to the fat pockets and reduce them from the inside of the eyelids. These fat pockets are herniated fat that has pushed forward and are causing those bulges to appear. No one could ever tell that you had surgery if we are doing reduction of the fat pockets from the inside of the eyelid. This procedure would be typical in my practice for someone who’s young.

When you are young, it is given that you have good skin quality so you are really not at risk for any creepiness or wrinkling of the skin, unlike somebody who is older or someone who’s had a lot of sun exposure. For somebody who’s in their 40’s or 50’s, I would routinely employ lasers and other treatments to improve skin quality. In your situation, at the age of 20 and with your skin type, I would probably not have to any additional skin treatment. I would just take out the fat pockets in a way that is appropriate for you.

You may wait until you are ready to move forward with this procedure but it is certainly fine to do this at this age. And as far as skin quality is concerned, you might see lines you haven’t noticed before but one of the golden rules of cosmetic surgery is people notice a lot of things after surgery that they didn’t notice before because they’re paying particular attention. That’s where having good photos before and after is helpful.  I hope this was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Lower lid bags at 20

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Thank you for your question about your lower lid bags,

  • 20 is not too young to have the surgery,
  • your skin should be fine, your bags are small, you are young.
  • the best approach is transconjunctival blepharoplasty - a small incision inside the lower lid removes the fat and leaves no visible scar,
  • this avoids complications such as scleral show,
  • Choose a Board Certified Plastic Surgeon or Oculoplastic surgeon
  • Hope this helps. Best wishes.

Internal Eyelid Approach

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I agree with most of the surgeons on this topic.  An approach through the red portion of the lower lid (transconjunctival approach) would improve your lower eyelid aesthetics. 

Dr. ES

Lower blepharoplasty eye bags

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I think that the relatively mild amount of puffiness in your eyelids could be camouflaged with filler injections. Restylane injected into the tear trough and upper cheeks would help blend the eyelid-cheek junction and smooth out the contour of this area. If you didnt like it, you could always have the filler dissolved and go with a surgical approach. I prefer filler injections to surgery for most patients in their 20s, unless the amount of fat herniation in the lower eyelids is severe. 

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 reviews

I think transconj bleph would not be that successful

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You have bags but the appearance of the bag is also caused by a depression or hollowing below the bulging fat. I have done midface lift combined with transconj blelph on someone 23 years old with an excellent result. If you email I will send you photos of that patient. I think although some doctors would think a midface lift is too much for you, I think it would definitely give you the best result.

Jeffrey Schiller, MD
Edison Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Eye bags

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At your age I would assume that these are hereditary.  They can be resolved either by surgery or some non-surgical treatments may help.  Using radio frequency on the area with the Thermage, Venus Freeze or Tripollar Stop to tighten the tissue and cause the lymph fluid to be reduced.  Of course, these treatments will require on going maintenance but sometimes the low risk options of non-surgical treatments is appealing.  Surgical procedures will give you the most dramatic and long lasting results.

It is best to seek a consultation from a cosmetic plastic surgeon to discuss your options.



R. Stephen Mulholland, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 101 reviews

Lower eye bags at 20

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Puffiness below the lower eyelids can be hereditary, as it is most likely in your case.  It is possible to have surgery to remove some of the fat causing the puffiness and this normally does improve the appearance.  The surgery can be performed by going through the inside of your lower eyelid so that there would be no scar.  At your age, the skin should not be an issue.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.