22 yo considering lower Eyelid Surgery to remove huge eye bags. Concerned with hollowness post-surgery. (photo)

Hi, I'm 22 and I've had these bags my entire life. I inherited them from mom and pop. I don't have thyroid problems or allergies and I maintain a low sodium-diet so we can cancel out those factors. They are HUGE and reach down to my cheekbones and they protrude even more when I look up. I want surgery but I'm TERRIFIED that once the bags are removed I will be left with hollowness!!! What do you suggest? Please help I'm tired of looking like a sad old lady instead of a young lady in her prime.

Doctor Answers 11

22 yo considering lower eyelid surgery to remove eye bags.

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Thank you for including excellent photographs. The solution to your problem is actually twofold: The maxillary bone support is somewhat deficient and the "circle " under the eye is prominent due to an adherent ligament which pulls the skin inward. Our best results have been directed at softening the lid-cheek junction by releasing the ligament and mobilizing the existing fat to dampen the sharp visible circle.We also add structural fat grafting which adds support under the eye to compensate for the maxillary bone deficiency.Both of these maneuvers are directed at preventing hollowness, which is critical.

Orange County Plastic Surgeon
4.6 out of 5 stars 22 reviews

Lower lid fat

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Thank you for your question. Dr. Kahn's comment below on "negative vector" and the need to ensure lower eyelid support is very important. Please make sure your plastic surgeon is board certified and is very familiar with all aspects of blepharoplasties (eyelid surgery). 

William McClure, MD
San Francisco Plastic Surgeon

Lower lid concerns in a 22 y/o

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You do have some contour issues but there are many ways to address them, from surgery to fillers and resurfacing.  See a local plastic/oculoplastic surgeon for an evaluation and options on how to best resolve your concerns and choose what is best for you.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Eye bags

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There are many different reasons for someone to have the appearance of bags under the eyes. Without being able to examine you from the limited views of your photos it looks like you have what is called a negative vector. Your eye is more prominent that the orbital rim underneath. There can be several ways to address this and many opinions as to what is best. Some options include fat removal, augmenting the orbital rim with filler or implants, or a mid face lift. The key I believe to the operation is to ensure that the lower eyelid has adequate support to avoid it from being displaced downward.

I encourage you to seek several opinions and select the individual that you feel understands the problem as well as your goals for surgery.

David M. Kahn, MD
Palo Alto Plastic Surgeon

Bulges under lids

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  • The photos indicate that your problem is excess lower lid fat that can be removed.
  • It runs in families,
  • Lower lid blepharoplasty to reposition the fat, to trim it or both will help,
  • A transconjunctival blepharoplasty avoids any visible scar. Best wishes.

Eyelid bags

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The eyelid bags represent herniated fat in the 3 compartments of the lower lids. It's good that you've rule out other medical issues as a cause for the bags. A trans-conjunctival approach under brief general anesthesia would involve conservative removal of the fat and restore the youthful contour to your lower lids. For many examples, please see the link below to our eyelid surgery photo  Gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Not every eye bag is caused by the same thing!

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Looking at your photos, I suspect that your lower eyelid "bag" is not caused by herniated orbital fat.  How can you tell?  Take your finger tip and put it on the top of the "bag."  If this feels hard, what you are feeling in the bony orbital rim.  Surgery does not remove this type of bag.  We don't chisel out the bone.  Now if this is the bony orbital rim, this actually makes you very good candidate for hyaluronic acid fillers.  Of these products, Restylane is the best of the products.  The big problem is finding the right person to do the service.  It is both an art and a science.  It is best if you are treatment by someone close to home in case the treatment needs to be adjusted.  Treatment for you will last a year or more.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Puffy eyes

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jitterbug, you have congenital pseudoherniation which basically means you have too muck fat behind your eyelids. In this instance only do I recommend removing fat from all three compartments behind the orbital septum. At the same time you need a midface lift called a "SOOF lift blepharoplasty" to improve the hollow area beneath the eye. I teach this approach nationally. See my web site for futher information. Good luck!!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Lower eyelid congenital bags and treatment.

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Lower eyelid congenital bags and treatment involves an experienced eyelid surgeon and removing ONLY the EXCESS fat with or without repositioning if u have hollows as well and is done thru a Transconjunctival  approach only. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Be careful jumping to surgery. Eyelid bags in your case are best trated nonsurgically!

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There are many reasons that people notice bags under their eyes, but the most overlooked reason is exactly the reason that young peolpe like you notice them.  Everyone has lower lid anatomy like yours with fat under the eye pushing against what we call the septum or the lower lid.  So why doesnt it show in everyone?  Because everyone has a different amount of midface volume and everyone looses this volume at a different rate.  good soft tissue volume in the tear trough and shape make this anatomy invisible while relative flatness like you have, make them more visible.

The answer to your concerns is a nonsurgical 20 minute procedure in which your cheeks and periorbital area ( the area around your eyes) are balanced and blended to make the bags disappear and make your face more balanced.  In my practice I call this procedure "Aesthetic Facial Balancing."  I even made a video of me treating myself with these principles to demonstrtate the point.  If you are scared of needles dont watch it! 

The key points to realize are that you dont need surgery- you do not have lax or weak lids, you dont have excessive preseptal fat and the shape of your eyes is beautiful.  Only accept a relatively unmodified hyaluronic acid filler- all others will cause further fat atrophy and premature aging.  The fillers that I feel are best are Perlane which is made by Medicis and Juvederm Ultra Plus made by Allergan.  Stay away from other fillers that are marketed as longer lasting or firmer, they cause big problems.  Perhaps most importantly find a doctor you trust that understands what you need and has the track record of success.  There are all knids of doctors injecting products and very few deliver a natural beautiful appearance.  I hope this helps!

All the best,

Rian A. Maercks M.D.

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.