What Can I Do For My Deep Grooves and Thin Skin Under Eyes?

Bags under the lower eyelids are usually caused by displaced fat, redundant muscle, redundant skin, or sometimes even a prominent vascular plexus giving the aesthetics of lower lid bags or dark circles.
Early volume loss in your upper cheek and tear trough area can exacerbate even a small amount of genetic predisposition to having eye bags. There are numerous, good options to address this issue ranging from nonsurgical to surgical. Which treatment option is best will depend on the underlying cause of the bags
It is important to realize that it is displacement of fat, NOT just excess fat that can cause lower lid bags. Old school blepharoplasty approach took skin and fat out of the lower lids by cutting right through the skin, which gave long term poor results with hollowed out lower lids and more potential for surgical complications. 
We know that we tend to lose fat as we age in our face, so taking more out as part of a surgical procedure may look good immediately, but it is a long term bad idea. Newer surgical approaches to lower lid blepharoplasty do not cut through the skin and leave no external scars, this is called the transconjunctival approach. More important yet, the existing fat is repositioned instead of removed, giving much better long term results with a more conservative surgical technique that also has lower potential for complications. 
Nonsurgical options include strategically placed volume to replace early loss, which can have a dramatic impact on the appearance of eye bags and the junction between your eyelids and cheek. Volume can come in the form of fillers or as micro fat grafting. 
Laser resurfacing can also address these areas when skin changes are the prominent player.

Thank you for the photos.  Fat is the answer.  Fat redraping through a blepahroplasty or fat injection. 

 

Dr. ES

You have significant hollowing in the lower eyelids and upper cheeks which can lead to a "tired" appearance. You would be a good candidate for filler injections, but I would recommend treatment of both the lower eyelids and cheeks to achieve the best results. There is a risk of some bluish discoloration, but I suspect this risk of this being a big issue is fairly small. If you didnt like it, the filler could always be dissolved. Other doctors might recommend fat injection, but I tend to like Restylane better in the under eye area. Aside from the hollowing under the eyes, you have a very youthful looking face and I suspect that treating this one area will make a big difference for you.

 

Hi Sing.  You are a great candidate for tear trough injections.  While surgery is an option too, most of our younger patients do not opt for surgery at a young age.  Restylane would be a great option to fill in the grooves you highlight in the photo.  It's likely that it would take about 2 cc's of product and last about a year.  In our practice this procedure costs around $1,000 for 2 cc's.  

View the photos below for results with the procedure.  Thanks.  

You are a candidate for lower blepharoplasty and fat transposition to tear trough.   You are also a candidate for non surgical fillers to tear trough.  Products like restylane fine line, juviderm refine, teosyal are excellent in this area.    There is also a role for PRP to enhance skin quality. 

Filler is actually a reasonable option. It just needs to be placed more deeply to prevent the Tyndall effect - blue discoloration from superficial filler placement. The results should last up to one year. The more durable option is a lower eyelid procedure where the small lower eyelid bag is advanced into the groove to give the lower eyelid/ cheek junction a more youthful appearance. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery