I'm 20 and have big bags under my eyes since I was 7. What are my best options? (Photo)

I am a 20 year old female and have had puffy eyes for as long as I can remember. I use to get bad allergies in the spring which I believed was the cause of it however I haven't had allergies in years & still have these bags. I am desperately looking for a procedure other than invasive surgery and I feel that the bags make me look unhappy and old. What is my best options?

Doctor Answers 7

Surgical and non-surgical eye bags treatments are both invasive, but surgery can be mild and lasts for the long-term

Thank you for your question. You’re 20-years-old and submitted a single photo stating you’ve had under eye bags since you were 7. Previously you felt your under eye bags were related to allergies, but as your allergies improved, the under eye bags remained. You are looking for a solution other than invasive surgery. You feel like the under eye bags make you look tired and old.

I can give you my perspective on how I approach patients like yourself in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and under eye bags is one of the most common issues we address in our practice.

To begin, it is very important to understand the relationship between allergies and other factors which contribute to the presence of under eye bags. Yes, allergies can make under eye bags look worse, but if the bags are always there regardless of allergies, there is something more anatomic that’s constant - that is called lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat normally around your eyes pushes forward and creates a bulge, which makes the eyes look tired.

We live in a time where there are more than a few ways to address the cosmetic appearance of the under eye bags, so it is clear you are concerned about undergoing surgery. I can share with you the way I discuss the options with my patients. For someone who has a small degree of puffiness that’s mild and present enough they notice it, but not significant enough that it  really pushed forward, we can offer the option of a non-invasive approach where a filler is placed under the eye bag in the hollow area. This area is commonly referred to as tear trough, and it’s still treated with a procedure. You stated you are concerned about  invasive surgery, but I would say that even placement of a filler is invasive - anytime you go through the skin, you are technically invading the space. So whether it is through a surgery or with an injectable, understand these are invasive procedures. They are different degrees of invasiveness, but it is still invasive.

We place filler using special instruments called blunt cannulas into the tear trough area, and add volume so the hollow becomes less obvious. When you place a filler in this area, you are essentially softening that appearance. The filler can last anywhere from 6 months to several years. Often, we also try to improve the skin quality with platelet-rich plasma (PRP). Platelet-rich plasma (PRP) improves the quality of the very thin skin under the eyelids which can be affected by the environment, or eye rubbing, allergies, and other issues which can make the skin look more older than the rest of the skin on your face, so platelet-rich plasma (PRP) is also an option.

Last is a surgical procedure but I would submit to you that it is less invasive than you may expect. The approach is called transconjunctival blepharoplasty where I address the fat pockets from the inside of the eyelid. Once I address the fat pockets, I’m reducing, sculpting, repositioning as is appropriate to get the most optimal result so the prolapsed fat is no longer is pushing forward. The appeal to this approach is that it’s a long-term solution. For someone who is younger who doesn’t have other elements of facial aging, a transconjunctival blepharoplasty, sometimes combined with platelet-rich plasma, is a definitive procedure and you don’t have to repeat it. I should say you don’t have to repeat it for many years, particularly when you are doing this when you’re young, so often eyelid surgery can last anywhere from 5 –10 years, but in a younger person it goes well beyond that. When we talk about fillers and other maintenance procedures, there is some ongoing placement and replacement as the material breaks down.

There are pluses and minuses to different options, so it is important you get a proper understanding and perspective. This means having a proper examination by meeting with a doctor who can offer you all options, not just one or the other. My recommendation is to meet with qualified, experienced cosmetic surgeons to learn about the options I described about lower eyelid transconjunctival blepharoplasty, the use of platelet-rich plasma (PRP) for skin quality, and the use of hyaluronic acid fillers such as Restylane for volume correction to try to soften the appearance of the under eye bags. Once you figure out what works best for you, you can move forward. I hope that was helpful, I wish you the best of luck and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Eye

Any topical, non-surgical treatments are temporary, at best. Blepharoplasty, or eyelid surgery, can fix bags, dark circles, droopy eyelids, and tear trough issues. 

Dark Circles, Eyelid Wrinkles/Bags -- Restylane or Belotero, Clear+Brilliant/Fraxel, Eclipse Micropen, Viva/Intensif

It looks like you have some fat loss under the eyes.Your bags can be treated with lasers, fillers, microneedling/PRP and skin care. Please see an expert. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

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Fillers

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.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 87 reviews

I'm 20 and have big bags under my eyes

You have under eye bags which is eye socket fat that has come forward with age but of course genetic is important too.  A long term solution to under eye bags (orbital fat prolapse) is lower blepharoplasty, which is best done through inside eyelid (transconjunctival) approach with fat repositioning. (Another option that camouflages the bags but doesn't get rid of them is filler injection.)  See following video and link.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 61 reviews

Bags under eyes

Its hard to tell based on the single photo you sent, but it looks like you have volume loss in your cheeks as well as some puffiness in your lower eyelids. It looks like you would be a good candidate for filler injections to help blend the eyelid-cheek junction. When your cheeks are flat, a minimal amount of puffiness in your lower eyelids becomes very visible. Adding volume to your cheeks will help camouflage the eye bags and make them look much less prominent. 

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 147 reviews

Lower eyelid bags

At your young age, your lower eyelid "bags" are hereditary. They are the result of prominence of the lower eyelid fat pads. Given you good skin tone and texture, you can consider hyaluronic acid (i.e. Belotero, Restylane) filler to the tear trough (just below the "bag") but this is not a permanent solution and runs the risk of making things looks worse. You need to find someone experienced in injecting this region of the face. Injection in this are is off-label. You would have the best, most long-lasting result if you considered surgery. You are a great candidate for a transconjunctival (incision inside the lower eyelid) blepharoplasty with conservative excision of fat. This would lead to the most natural-looking results. Good luck!

Katherine Zamecki, MD, FACS
Danbury Oculoplastic Surgeon

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