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

Question

I have been researching eyelid procedures as I just turned 30 but look much older due to the lower eye bags. They can’t be covered with makeup, and are worse when I tilt my head downwards. If I tilt my head upwards they slightly disappear. My cheeks are also deflated probably from weight loss in my 20s. The problem is I’m getting mixed answers from my consults and there’s limited surgeons where I live. Some say fat transfer some say just move the fat that’s inside. Some suggest fill only.

Jason Emer, MD · Answer

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.

Nancy de Kleer, MD, FRCSC (Plast) · Answer

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

Reza Ahmadzadeh, MD · Answer

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!

Angelica Kavouni, MD, PhD, FRCS(Eng) · Answer

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

Farhad Rafizadeh, MD · Answer

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.

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

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

Answers (10)

Answer: Eyelid surgery

Answer: Eyelid surgery

Answer: What are my options with early eye bags?

Answer: What are my options with early eye bags?

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Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.