Is 23 Too Young to Consider Lower Eyelid Surgery? (photo)

I am 23 years old and have always been dark under my eyes, I believe this is hereditary. Recently I have noticed this has worsened (I used to be able to cover the darkness with make up, but I seem to have more of a "hollowing" now). I am concerned about whether I am too young to be considering surgery or treatment in this area. People have been asking me if I'm tired and I am worried this will only get worse as I get older. Any advice would be appreciated.

Doctor Answers 14

Young adult with dark circles under the eyes

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Topical products such as Skinmedica dermal repair for eyes can be of benefit.  This particular product has Boron in it and helps to reflect the light making the appearance of the dark circles less.  Also products such as this and Retin-A help to thicken the epidermis. Circles under the eyes appear dark because the skin is thin and there are many blood vessels and muscle directly under the skin.  Some patients will benefit from microablative CO2 laser treatment to tighten the skin and  soft tissue fillers such as Juvederm to fill in hollows.

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Treatment of undereye fat bags and hollowness

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You have a combination problem of undereye fat bags coupled with premature hollowing of the eyelids.  At this stage, you may first consider a non-invasive option such as Belotero or Restylane injections to the eyelid hollow. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Skin Care and Non-Surgical Procedures

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On a younger person, the area from the rim of the eye (also called the orbital rim) and the cheek area has a little more fat and thickness. But as I looked at your photos, your under eye area looks a bit hollow. I also noticed a bit of puffiness underneath the eyes.

Very often when people become very lean or have very low body fat, they tend to also get hollowed out in the face. If you’re engaging in a lot of athletic level activity, then this might also be a possible cause. If not, then you’re basically dealing with a genetic trait.

One solution that we offer is the non-surgical eye lift. In this procedure, we add volume in the tear trough area to the under eye area and place a material called hyaluronic acid that goes under the trade name Restylane. By this, we’re filling the skin and adding some volume to help the contour look softer. This make my patients look less tired and natural. In addition, if you have any issues with skin quality, for example if you are exposed to a lot of incidental sun exposure, a good sun block, under eye moisturizing cream, even something in the retinol family can help refresh the skin. A lot of times, when the skin luster gets dull, it makes someone also look tired.

Again, you are young, so maybe you’ll be satisfied with something that can last for several months. My suggestion is that you meet with a couple of cosmetic medical specialists with experience, background training and aesthetic sense that can assist you in this area. You may want to lean toward someone who has a lot of experience with eyes because this is a delicate area and you certainly don’t want to look like you’ve had a procedure.  I hope this was helpful, and thanks again for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Eye bags at 23

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Thank you for your question about your lower lids. My thoughts -

  • the photo suggests you have excess fat in the lower lids, which is not from age. It causes the darkness, is inherited and gets worse with time.
  • You are young, a permanent correction I believe is better than injections.
  • I recommend a lower lid lift (blepharoplasty) specifically to free the fat from its pocket, re-drape it to smooth the crease and trim any excess. Once healed, you should look rested and not get those 'tired' comments.
  • Hope this helps.

Filler for the tear trough

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You would not be too young to consider a treatment that would improve the appearance of your tear trough. This can be hereditary as you mentioned. Restylane is a fantastic filler for the tear trough, and can yield a great result when the injections are performed correctly. I would recommend a consult with a board certified plastic surgeon, facial plastic surgeon, or dermatologist. I hope this helps, and best of luck to you. 

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Surgery at 23 for Eyes

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It looks like your main problem is simply some deepening of your tear troughs. Though surgery could absolutely correct this problem, you could also try an injectable like Radiesse or Restylane in the meantime. It could give you a preview of the results and would be cheaper, with no recovery.

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon

Tear Trough Concerns at 23

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     The area of hollowing can be blended temporarily with a hyaluronic acid derivative like Restylane.

Options for treatment under eyes in 23 year old

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Your age alone does not prohibit you from potential treatment under your eyes.  My recommendation would be to try Restylane injections to improve the depressions that you have under your eyes.  This should help to reduce the shadowing that you have that creates the darkness there.  

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

Age is never the issue.

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You will not benefit from lower eyelid surgery.  You have a pronounced tear trough.  You very best option is to have Restylane filler to fill in this hollow.  Juevederm and the newer Belotero are not the right products for this application because these products tend to spread after injection.  It is critical that the products stay precisely where they are placed.  Look for a very experience injector who does a lot of under eye treatment.

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

Peri Ocular Surgery??

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 Yes, you are correct. Your condition is most likely hereditary and it most likely will only get worse with time. Yes, you get to blame this on your family and you should be able to see what you will look like in the future by looking closely at them. The question is when and how to address your concern. Initially, fine Facial fillers with bleaching creams may be of assistance for a short period of time (months to years). After trying fillers you may decide for a more permanent solution such as Fat Grafting to the area with some laser resurfacing. Consider a consult with a member of the ASAPS in your area. They are experts in peri ocular surgery. Best,


Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

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.