I'm only 23 and I've had eye bags under my eyes my entire life. Any suggestions? (Photos)

Question

Hello. I'm only 23 and I've had eye bags under my eyes my entire life. I'm moving to Valencia Spain and want to look for treatments. Is there a specific surgery or treatment recommended considering the photos I have uploaded? Thank you.

Jason Emer, MD · Answer

There are many things you can do to treat under eye bags, but a combination approach with nonsurgical treatments would give the most improvement: fillers (Belotero, Juvederm Volbella), lasers (Fraxel/CO2), Renuvion (J-Plasma), microneedling/PRP, Cosmelan peels and stem cells. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest getting a formal evaluation with a cosmetic dermatologist to see what is best for you and your goals. Best, Dr. Emer.

Adam Scheiner, MD · Answer

Dear 1994, 
It appears that you have evidence of fullness in the lower eyelid region and festoons/malar mounds on the cheek as well.
  
These changes can make a person appear tired, sick and older even when they feel fine inside. While these usually appear as people get older, in certain individuals they can form at a younger age. 
The best options would be surgery to remove or relocate the fat in this region and a procedure to improve the skin quality in the lower eyelid at the same time.
  
Festoons and Malar mounds are difficult conditions to treat but I've had success using laser to help with this condition.
  
I'll include some links below.
  
I hope this was helpful.

David Samimi, MD · Answer

I can see the issues that bother you on your lower eyelids. There are 2 of them, the first is the appearance of hollows just beneath your eyes which give the appearance of "bags", these are seen most when you are looking up. The second is the appearance of a second set of bags lower down more on your cheeks. These 2 bags are there for different reasons and thus there will be a difference in success with treatment. The first set of bags is from relative hollowing of fat/soft tissue over the bone just below your eye and genetic changes in skin color in the area. The best two treatment options for this are filler or surgery. Filler has the benefit of having minimal to no downtime, is cost effective in the short run and if performed by an experienced injector can give very natural results. Possible downside is the limited longevity of the result, can look lumpy bumpy if not performed by expert and some patients do have adverse reactions to filler. On the other hand surgery may provide a longer lasting result but will be associated with a  higher cost to start and obvious bruising and swelling that usually lasts 1-3 weeks. Also eyelid surgery is complicated and especially on a lower lid such as yours the surgery should be performed without an external incision (transconjunctival) to minimize any noticeable scar or unnatural appearance. In best case scenario, surgery will improve the appearance of the hollow and from shadowing but the changes in skin color usually just need a good cover up. Moving onto the second bags which are more difficult to treat. There are a variation of what we call a "festoon" or malar bag and are there because of the ligaments that hold up the face. These ligaments connect the skin to the lining of the bones on the face and thus can be very difficult to easily change. Skin care, good makeup and partial acceptance that these cannot always be improved 100% is important here. Overall, I would recommend starting with an experienced injection who performs a lot of eyelid filler, and leave the option open for surgery ideally with an oculoplastic surgeon who is a member of the American Society of Ophthalmic Plastic an Reconstructive Surgery (ASOPRS) Safe travels to Valencia!

Jonathan Kulbersh, MD · Answer

Under eye bags can be permanently corrected with surgery or temporarily camouflaged with fillers.There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eyelift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye.
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. Cost will vary and can be discussed at your consultation.
I hope this helps!

Renata Khelemsky, MD · Answer

Hi and thanks for your photos and questions.  The issue of lower eyelid "bags" usually falls into one of two categories. One can be an anatomical finding of a tear trough "valley" under the eyes.  This has to do with the position of your cheekbone and the bony anatomy under the skin and muscles.   Another problem, usually found in older individuals, is a pocket of fat under the eyes that bulges and creates puffiness, causing the typical tired and aged appearance.  There are certainly individuals who have a combination of both.  From your photos. it appears you are a thin athletic girl and given your young age, I would consider the possibility of a deep tear trough.  A clinical examination from the profile can help evaluate this.  A careful placement a thin, flexible filler can improve this appearance, smooth the contour, and decrease the shadows seen on your photos.   Lower eyelid surgery may be considered after a thorough in person evaluation.  Some younger patients seeking a more rested appearance may be a candidate for lower eyelid surgery in which the fat is either removed or repositioned.  All the best to you in your travels!

Camille Cash, MD · Answer

You have different options to explore.  You can consider a lower blepharoplasty surgery.  This will remove excess fat and skin revealing a smoother under eye appearance.  Other less aggressive options include the ALMI procedure.  This is done in office and uses your own tissues to help add volume and improve skin tone and texture.  You can also consider fillers to help disguise under eye irregularities.  This treatment lasts approximately a year.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question.  Based on your photo the dark circles are depressions underneath the lower eyelid or what makes the appearance of puffiness of the lower eyelids more visible.  The most effective treatment is a procedure called a trans-conjunctival lower eyelid blepharoplasty with arcus marginalis release and fat grafting.  However it is important that you consult and experienced a board certified plastic surgeon who is familiar with this technique for a proper diagnosis and recommended treatment.

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