What would be the best option to target under eye bags? Getting mixed answers and unsure where to start (photos)

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

I agree that there are 2 findings on your photos - lower eyelid bags and cheek deflation.
The most definitive way to treat the lower eyelid bag is a transconjunctival blepharoplasty (TCB) to remove the fat. You can then follow this up with filler to the midface a few months later if you desire.
You can consider filler alone rather than surgery, as if done very well, it can camouflage the lower eyelid bulge and you can avoid surgery, it will last long if done very well, but not as long as surgery.
Fat grafting can be used in the same way as filler instead of filler, however I find filler to be more precise.
You do have various options, because your findings are not severe. For severe lower lid bags I recommend surgery, however you have options.
Please keep in mind, that without a physical exam, I can only offer advise based on what is seen in the photo, however an in person evaluation can provide you with more information.
All the best to you,
Dr. Nancy de Kleer

Hi, this is common question. As you described, there are different ways to treat this issue. Based on the photos that you provided, I think you would benefit from a combination of both reduction of the fat pads through an approach from inside the eyelid, and then also with fat graft to the cheek and infraorbital region. An in person consult would be necessary to provide you with a more accurate answer. All the best!

I would advise to fill the midface at this stage , there is lack of volume , it will immediately improve the facial balance. I suggest you start with a filler before committing to fat transfer. Very conservative eye bag reduction may help but beware that it may affect the shape of your eyes. Best wishes

You are obviously young and you could wait till this becomes more obvious. At this time your options are transconjunctival blepharoplasty or as a temporary solution Restylane injection in the tear through are done by an expert safely as injection this area could be very dangerous to you vision.

There is no doubt, based on these photos, that you may benefit from lower blepharoplasty. Sinc e your problem is tear trough and small fat bags, this entire procedure could be done through a inside the eyelid incision. Small cheek bones are usually reason for such an early presentation. Hope this helps.

Fat Transfer is expensive, a two-step (to withdraw the fat from the donor site and to reimplant it in the recipient site) minimally invasive, relatively expensive process. Now, despite the claims to the contrary all the fat does not survive in the recipient site. But, that which does can be difficult to remove should there be an adverse reaction immediately or down the road. Since the bags are ther result of volume deficit in the supportive under eye region. This can be easily remedied by the proper injection of an appropriately robust filler in the upper cheek region (that would not only recontour the cheeks and create a more oval, heart-shaped face), but would immediately improve and rejuvenate the suborbital area by diminishing the bags. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

In most patients, eye bag removal surgery involves removal of some of the protruding fat from under the eyes, as well as performing fat grafting to the face

The under eye bags that you're referring to are herniated orbital fat creating the puffy look. When they are significant enough, a lower blepharoplasty procedure can accomplish a conservative removal of that fat through a trans conjunctival approach. The Incisions are located completely on the inside of the lower lids. No external incisions are required. The procedure is performed under a brief general anesthesia as an outpatient procedure.

The 'reason' for the appearance relates to a reduced 'bone support/structure' 'under' the eyelid. At your young age, the tissue contours can be improved more simply with 'limited' filler towards the outer aspect of the area; and avoiding the 'inner/near nose' area (that would yield an unnatural look). Ultimately, one can consider augmentation long term of the 'cheekbone' area which 'tents' the tissue and reduces the appearance of 'lines' under the lower lid. The varying looks with tilting the head relate to the lack of bone on the lower eye'socket'/cheekbone.