Help with ugly sunken, hollow deep under eye bags! (Photo)

Unfortunately, fillers are also expensive and their maximal clinical fades after about a year.  More filler would then be needed to restore the volume again.  For this reason, in the long run, you don't save any money choosing fillers as an alternative to surgery.  No question though you, you can get immediate benefit at a fraction of the cost of lower eyelid surgery right now.

Obviously, an in person exam would be the gold standard for evaluating your face.  That being said, it appears from your excellent photographs that your maxillary bones, including your infra orbital rims, are retrusive and underdeveloped.  Therefore, if you were my patient, I would inject Voluma to bring out your infra orbital rims and increase both the volume and projection of your maxillary bone.In my experience, Voluma does an excellent job of adding bulk to the infra orbital rim which then pushes the undereye bags upward, decreasing their projection and, at times, completely eliminating the visibility of these infra orbital saddlebags.  At this point, I would recommend you see one of the many incredibly knowledgeable and well trained Board Certified plastic surgeons in Atlanta, Georgia.

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

Thank you for your question and images. You look like a good candidate for lower eyelid surgery. I understand that you are concerned about the costs and although fillers may sound cheaper at first you will be surprised at the costs over the long term. Your eyelid bags are well defined and relate to herniation of the middle and medial lower eyelid fat pads. Thus can be significantly improved through an invisible lower eyelid incision. My advice would be to discuss your concerns with a plastic surgeon and add up the differences between the two treatment methods. You may be well surprised.RegardsDr Guy Watts

 Thank you for sharing your question. The treatment of choice in your case is having blepharoplasty performed. You might get some improvement with the injection of dermal fillers, but this can only be determined by in-person evaluation. See an experienced Oculoplastic Surgeon for comprehensive evaluation and discussion of possible treatment options. Good luck,

Fillers, lasers, microneedling/PRP do very well to treat this area. I suggest you see an expert.  Best, Dr. Emer.

You have some prolapsed fat and deep tear trough.  While surgery is a great option, non-surgical treatment would be to put some HA filler in below the fat. This will help to smooth out the area, and make it look less dark. The filler usually lasts at least a year here.  Best options are Restylane or Belotero.  Juvederm not a good filler for this area due to edema.     

Your pictures show infraorbital fat prolapse and mid face deflation causing contour irregularity. Although lower eyelid blepharoplasty with fat preservation/redraping will smoothen the contours, you can also consider a less invasive approach with hyaluronic acid fillers (hyalu-blepharoplasty). The latest will camouflage the fat prolapse, improve the midface projection and smoothen the eyelid-check junction. It is not a permanent procedure but could delay the need for surgery.

Filler injections such as Juvederm, Restylane, or even your own fat can help fill up the hollows and mask the bags.

Dear dr7423:Thank you for the question. And although the pictures are pretty good, they cannot replace a thorough face-to-face examination. So, that would need to be done for you to get the best recommendation. Having said that, I will say that you certainly seem to have both of what you complain of: hollows AND "bags". How can this be, since one is a protrusion  and the other is an indentation? It is so because the eyelid tissues (extra skin and fat) do bulge outward ("bags"), and then, below the bulges are "troughs" or "hollows". So, to get a full correction, both removal of bulging tissues (skin AND fat), with lower eyelid surgery,  and then some "fill" of the "hollows" (injectible "fillers" would be cheaper, but some of your fat might be better) would be best. However, this combination would not be cheap--but, financing is usually attainable, and if it really bothers you, look for the best treatment. Talk with a board-certified  plastic  surgeon in your area and see if he or she agrees. Good luck!James H. Scheu, M.D.