Alternatives to Surgery for Puffiness and Eye Bags?

Question

Other than surgery, are there any products or lasers on the market to target the under eye puff and bags?

Steven J. Pearlman, MD, FACS · Answer

It is difficult to give specific advice on "eye bags" without an examination. Bags usually come from the fat around the eyes protruding which can be either inherited or come on with age. If there is a hollow area beneath, called a tear trough, it can be filled with an injectable such as Restylane. However, the skin in this area is very thin and patient selection is important. The best treatment is usually surgery to either remove the excess fat or take the extra fat and move it to adjacent hollow areas. This latter procedure is called fat re-positioning.

Leila Kasrai, MD, FRCSC · Answer

For eye bags and hollowness, fillers would be suitable. Fillers add volume to smooth out the area. For general wrinkles and crepey skin, fillers, laser skin resurfacing and Botox can help depending on the location. For puffiness, this would need to be examined. If the puffiness is caused by bulging fat, then surgery would be probably be the most suitable option.

Eric M. Joseph, MD · Answer

The appearance of bags in your lower eyelids is usually due to a groove that forms between the lid-bag, and cheek. By placing Injectable Fillers in the lower eyelid groove, you can camouflage them and dramatically improve your appearance.
I've attached a link demonstrating a photo using Silikon-1000 to permanently reduce the appearance of lower eyelid bags.
I hope this is helpful, and best regards.

Robert W. Sheffield, MD · Answer

Thank you so much for your question! Eye puffiness as well as eye bags, while they may look unsightly, could be improved. That said, it is important to always be careful in using products or undergoing treatments to fix them. Now, depending on the severity of the puffiness or the bags, various treatment plans can be executed by a board certified plastic surgeon.  If your puffiness or bags are not severe or just starting out, you get good results with topicals although these may not last long or will not totally eradicate the issue – only improve it minimally. Topicals also do not help in eradicating the root cause. Should your puffiness or bags become severe, the best option would be surgery.  So, if you are looking to improve such puffiness or bags, do consult a board certified plastic surgeon and have the puffiness evaluated. After assessment, he or she will be able to guide you in deciding which best solution to solve your issue. Hope this helps!

Jeffrey Zwiren, MD · Answer

You would be a candidate for a lower eyelid blepharoplasty. If you have herniation of orbital fat causing bags of the lower lids with lack of soft tissue fullness. These features can be corrected with a lower eyelid blepharoplasty. If the condition is only lose skin then you may want to consider SmartSkin or SmartXide microablative fractionated CO2 laser resurfacing. A consult would be needed to advise you which procedure would meet your expectations. Other choices would include soft tissue fillers such as Juvederm.

Samer W. Cabbabe, MD · Answer

While many products will claim to improve this problem, if it is fairly severe then surgery is your best option. Some topicals will help the skin improve minimally but will not help the underlying tissue weakness.

Robin T.W. Yuan, MD · Answer

The appearance of bags or shadows under the eyes is not due to one specific problem. This can be caused by many anatomical variations from pigmentation, to capillary blood flow, to excess periorbital fat, to loose membranes, to under-developed bony structures, to skin laxity, etc. The solution would be dependent on the cause. Surgery is not always the answer.

Steven Schuster, MD, FACS · Answer

Dear Meowtz
Bags under the eyes can be from many sources.  It may also depend upon your age and heredity. Some patient I have taken care of are genetically predisposed to fat herniation and request a blepharoplasty at an early age. In other patients there is not fat popping through the lid but cheek puffiness or what is referred to as malar bags.
Either way, there is no treatment other than surgical for the removal of fat from under the eyelids.  I would suggest a consultation with a board certified plastic surgeon in your area to determine the nature of your problem and how best to treat it.
In young patients with isolated fat deposits a transconjunctival lower lid blepharoplasty can be performed with very rapid healing. Others need a more classical open blepharoplasty and some may need a combination of surgery and laser to achieve the best result.
Good luck in your search.

Tracy Pfeifer, MD · Answer

Undereye bags can have several components and usually it is due to a combination of factors. One factor is that the fat underneath our eye starts to pooch forward; this gives the puffiness and is only corrected by surgery. In some countries docs will inject this fat to "dissolve" it but this is not FDA approved in the United States. A second component is that we start to get a tear trough; that is the line from the inner eye that travels down towards the cheek.  
This tear trough is a concavity or depression; the puffy fat above it is a convexity. Thus, the tear trough will accentuate the appearance of the puffinesss above it. So, if you have the trear trough filled in with an injection of Prevelle or Sculptra or Radiance, or whatever soft tissue filler your doc recommends, it will minimize the disparity between the puffiness and the depression; and the puffiness will appear less prominent.  
I use this technique often in patients who do not want surgery.  I also recommend that you keep your skin as healthy as possible by increasing the amount of collagen in your skin.  This will keep your skin thicker and thus more able to camaflouge these changes.  Vitamin A derivatives such as Retin-A and retinol increase the amount of collagen in your skin.  
Hope this helps.

Brooke R. Seckel, MD, FACS (retired) · Answer

Some doctors are attempting to remove eye bags with suction and other "non-surgical"laser methods-in my opinion these are dangerous techniques and risk eye injury. Dont try them.
Filler injections can plump the depression beneath the eye bags, but the bags remain!
Filler injections into the eyelids cause frequent problems such as visible lumps and discoloration so be forewarned.
If you need a blepharoplasty to remove eye bags then have it--these procedures are time proven and safe in the hands of an experienced board certified plastic surgeon.
And importantly-see a board certified plastic surgeon with experience in eyelid surgery. Many non surgeons offer these procedures and simply do not have the training and experience to safely achieve a good result.

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