23 Year Old. What Can I Do About Bags Under my Eyes? (photo)

You are concerned that your skin is loose particularly when you smile and this is certainly a common concern that a lot of people have. With the photos you submitted, I can assess that your skin is very light. People who have very light skin tend to have the skin under their eyes are almost transparent, and you can see the red quality of the muscle and the blood vessels under the eyes. If you have very light and thin skin, when you smile, the wrinkles are more obvious.

What you are experiencing is basically genetic. However, we can control the environmental factors affecting the skin. In my practice, if someone has light skin, I always advice them to protect it using sun block and moisturizers. You should do everything you can to reduce the environmental that can accelerate age-related changes. We sometimes refer to sun exposure as photo aging. Since the eyelid skin is the thinnest skin in the body, I also remind people to avoid toxins such as cigarette smoke.

There’s a subtle hint in your photo of slight puffiness under your eyes. In our practice, when someone has a slight amount of puffiness, we tend to avoid doing a surgery as the first procedure.  Instead, we give the option of a temporary procedure which helps the appearance of that slight puffiness. I suggest using a filler that is placed in the tear trough area as well as in the eyelid to cheek area to add a bit of volume and soften the transition between the two. It’s done very conservatively and in a way to minimize the chance of lumpiness. The material we typically use is something in the hyaluronic acid family called Restylane.

Another thing that we can do for patients with thin skin is to build up the collagen. We do this with a procedure called platelet-rich plasma, which draws your own blood and then we concentrate the part of the blood that has the active healing properties. It’s like getting a cut and that cut heals with the cells called platelets. In other fields of medicine, this particular technique is used to help athletes and they inject it into their joints. In the field of cosmetic surgery, we use it under the skin. We found out that we’ve been able to help a lot of our patients with this injection treatment. Often, we need to do more than one injection over the course of several months, and patients really appreciate the improvement in skin quality. In fact, a lot of our staff members avail of the same injections themselves.

I suggest that you take conservative options first, and if you notice that the puffiness under your eyes is more constant and prominent, then you may want to consider a surgical procedure. To summarize, I recommend  a filler for the tear trough area and in the eyelid cheek junction and also platelet-rich plasma to help with skin quality improvement.  I hope that was helpful, and thank you for your question.

I personally do not believe that Boletorois the right product for this area.  I recommend Restylane.  Please find someone who does a great deal of this know their eyelid anatomy.

From the photo provided, we can see a couple of features:

You have mild prolapsed lower eyelid fat, and there is also a slight reddish purple hue to the skin. This is due to the very thin skin of the eyelid allowing the muscle underneath to be visible.

Unfortunately, short of concealing creams, there isn't much to be done with the color, however the transition between the between eyelids and cheek caused by the proplapsed fat can be improved. There are a couple of different ways to address this:

1. Transconjunctival blepharoplasty [surgery] to excise or, more likely, reposition your eyelid fat.       

or

2. Injectible fillers [Restylane, Boletero or Juvederm] to fill in the hollow between the eyelid and cheek. I would recommend staying away from longer acting and non reversible fillers such as Artefill and Radiesse in this region, because if you are not happy with the injection, they are not easily removed, whereas the Restylane, Juvederm, or Boletero can be easily reversed with enzyme injection.

Both surgery and fillers are effective. The surgery is a more permanent solution but is more expensive. The fillers are temporary [last 6-12 months on average, but sometimes longer] and is less expensive, but need repeat injections.

Seek an experienced surgeon/injector.