28 Years Old With Eye Bags - Eyelid Surgery Only Option?

I am 28 years old with eye bags. I am interested in what cosmetic procedure could help get rid of them. Is eyelid surgery my only option?

Doctor Answers 18

Treatment of dark circles under lower eyelids

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Dear Jazbow,

From your photo your lower lid deformity has two components.  I believe that there is an exaggerated length between your pupil and lower eyelid-cheek junction.  There has been an explosion of experience adding volume to help elevate the eyelid-cheek junction.  There are no perfect fillers but there are many which could help improve your lower eyelids which has less downtime and risks than operative intervetion in an office setting.  Secondarily the lower lid pigmentation is best treated with concealers.

Tyler Plastic Surgeon

Eyelid surgery would definitely not be a good option for you

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From the photograph, it looks like the muscle under the eye at the lashes (the obicularis muscle) looks thickened and the area underneath it looks hollow.  The dark circles are a combination of this muscle being thicker than normal (which some people are just born that way - and this can be relaxed with a little bit of BOTOX), and the area under the eye which is hollow from a lack of volume, which may be due to the way the bone structure in the face.  Eyelid surgery would definitely not be a good option for you.  Instead, I would use injectable fillers such as Juvederm and possibly in combination with BOTOX, which will give a much more natural result.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon

Eye Bag Treatment

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What might appear to be a large bag near the lower lid is often caused by an underlying depression or shallow area that catches shadow when light is coming from overhead.  This is particularly true in young folks like yourself as the aging process has not yet begun to distort youthful anatomy.  The attached photo is difficult to discern, but nonsurgical procedures such as hyaluronic acid filler injections can often help immensely.  Once the topography and shadowing are improved, the pigmentation issues are usually found to be minor if present at all.  Topical products can be used to treat true hyperpigmentation.  In rare cases, surgical fat removal might be needed in a young person, but a good exam would be required.  Hope this helps.     

Brian M. Braithwaite, MD
Chicago Plastic Surgeon

Option for eye bags.

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We do not recommend injections around the eyelids due to complications we have seen in patients from other offices. We recommend a transconjunctival blepharoplasty to remove the lower lid fat pads so that there are no external incision.  

Lower Eyelid Bag Treatment Options

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Hi jazbow,

Thank you for sharing photographs.

Generally, there are a few options to improve the appearance of the lower eyelids, eye bags, or dark circles. First option includes basic skin care, tretinoin, and/or chemical peels. This nonsurgical method helps improve the skin quality, reduce pigmentary changes, and improves overall appearance of the lower eyelid & cheek areas.

Second more advanced option is an injectable filler or fat to plump up the area. Fillers are made of material that is slowly removed over time, such as Restylane. Facial fillers treatment is performed in the office vial local anesthesia.

The last option, and also the most aggressive, is eyelid plastic surgery. Cosmetic surgery of the lower eyelid may remove or reposition fat in the eye bag area, and possible remove some sagging skin. Plastic surgeons typically don't recommend cosmetic eyelid surgery in young patients. However, each patient is unique and circumstances may vary. Age alone is not a determining factor if a person is a cosmetic surgery candidate.

Only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki

Do I need eyelid surgery or fillers?

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Though it is tough to say with only one photo, I would consider a filler injection in the the hollow under the eyelid.  this is low risk, minimally invasive, and often very effective in younger patients. 

Neal Goldberg, MD
Westchester Plastic Surgeon

Lower eyelid depressions

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I often will inject restylan under the eyes for minor depressions in young patients such as yourself, but it is hard to say from one photo. An exam is key.

Restylane is great for under eyes.

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You seem like an ideal candidate for this.  It's just tricky technically, so go to some one with experience.  The Restylane should be injected deeply under the muscle and in tiny quantities.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Based on your photo, your lower eyelid bags may be improved by a well-performed Injectable Filler treatment. Video attached.

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I read your concern and reviewed your photos. In my practice, I nearly always suggest a non-surgical approach for improving the appearance of lower eyelid bags. You appear to have typical grooves between your lid bags and your cheeks that would benefit from a well-performed filler treatment. In my view, you should avoid fat removal from your lower eyelids which may result in a hollow, "operated" appearance.

I attached a link to a photo demonstrating non-surgical lower eyelid rejuvenation using Silikon-1000, an off-label filler for permanent results.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 430 reviews

Would recommend that you consider Restylane filler.

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You are young and the lower eyelid fullness is minimal. It is likely that you will do very well with just lower eye filler. If you decide you don't like the need to repeat the service, then the alternative would be lower eyelid surgery in the form of an arcus marginalis release.

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