Best Bags Under Eyes Treatment?

I am 33 years old, and the bags under my eyes make me look older. It seems they bring down my whole face. Also, my left eye is starting to droop, and therefore that side of my face seems to be sloping down. What is the best procedure(s) to restore a more youthful look?

Doctor Answers 11

Treatment for Facial Asymmetry

Facial asymmetry often results from sleeping on one side of the face more than the other. It can also be caused by an uneven aging process. Developmental differences can also result in asymmetry of the face. Blepharoplasty to remove extra fat and skin from around the eyes can even out the appearance and give a less tired look. Skin resurfacing with an Erbium laser and fillers can enhance the results and add to the treatment of asymmetry of the cheeks and smile lines. It is hard to tell from the photo, but if the upper eyelid is closing, a ptosis procedure can be performed to elevate the falling eyelid. I hope this is helpful to you.


New York Oculoplastic Surgeon
5.0 out of 5 stars 124 reviews

Surgery may be needed for bags under eyes

My recommendations are completely different. Before one recommends what could or should be done, the current condition needs to described or diagnosed.

From the photo, you can see facial asymmetry that goes down to the level of the bones and contributes to the eyelid appearance. The outer corners of the eyes should be 2 mm above a plane defined by a line joining the inner corners of the eyes. In your case the right outer corner is where it should be but the left is below this plane. That makes the outer half of the left lower eyelid margin droop slightly downward and outward. Because of this there is only 1 bag on the right due to protruding fat (psuedoherniation). On the left there is an upper bag of muscle and a lower bag of bulging fat. No amount of chemical peeling or lasering of the surface skin will correct this. In my opinion there is little or no excess eyelid skin but the degree of excess at this level can only be discerned during a face to face examination

My recommendation would be to try and raise that left outer corner of the eye, remove the covering under the skin and over the bulging fat and suture that fat to the deeper cheek fat in order to camouflage the line you see in the photo that demarcates where the eyelid ends and the cheek begins (nasojugal groove). The muscle under the 1st bulge on the left may need to be thinned and any excess skin found at surgery should be removed.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Topical Cream for Under Eye Bags

One of the most common complaints in facial aging is lower eyelid bags.  This often begins before other gravitational facial aging becomes apparent.  Patients who experience the lower eyelid bags are typically in their 30s or 40s and are not ready for more permanent surgical solutions such as lower eyelid blepharoplasty.  Solutions include but are not limited to surgery, topical treatments, laser or resurfacing procedures such as chemical peels, and fillers.  

Two topical alternatives which are interesting because of their immediate and oftentimes impressive results are NeoTensil and Instantly Ageless.  NeoTensil is difficult and slow to apply and has a high price point.  Instantly Ageless from Jeunesse is equally effective with a much easier application process and a much lower price point.  For those patients who are bothered with lower eyelid bags and are not ready for surgery, this product can be very helpful.

John L. Burns Jr., MD
Dallas Plastic Surgeon
4.7 out of 5 stars 41 reviews

Great treatment for Lower Lid Bags and a "Tired Look"

The "BEST" treatment for lower lid bags and a Tired Look is NOT one treatment but several treatments.

I would first recommend you have a "Weekend Peel" Sciton Joule ER;YAG Laser resurfacing of the lower lid. Which would in most cases allow you to have the procedure on a Thursday and return to work on Monday. It will tighten the lower lid skin and VASTLY reduce skin looseness and bagginess. Once the swelling is gone in less than a week, I would fill the Tear Troughs which contribute to this look with Restylane smoothing this arch like depressions.

These two treatments would greatly improve the appearance of the eyes.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 104 reviews

Eye bags, circles, and swelling

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  The majority of people have multiple causes so many people benefit from more than one procedure to fix this. For instance, blepharoplasty with fat grafting and/or laser. Below I have listed some common causes with targeted treatments for each cause. You need to see a surgeon experienced in this issue for a good facial analysis so that you get the best treatment.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Eyelid Rejuventation

Thank you for your questions and for providing a photo.  The primary issue, as you mentioned is the lower lid bags.  You appear to has excess fat in that area.  This is not fat that comes and goes with weight changes, it is structural fat which tends to be permanent.  Most likely you would do best with a conservative lower eyelid transconjunctival blepharoplasty.  That involves an incision inside of the lower eyelid and removal of the excess fat.  There is no external incision and no stitches are needed.

Your upper eyelids are getting a little droopy and that adds to your tired look.  However you do not have a lot of extra skin and no extra fat in your upper lids.  You would need an in office evaluation to know for sure, but I think you would benefit greatly from a internal eyelid ptosis repair (Mullerectomy).  Again this is a surgery performed from the inside of the eyelid.  One of the minor muscles is tightened so the eyelid sits in a slightly higher position which will make you look a little more bright eyed and younger.  Again there would be no incision on the skin, however you would need dissolving stitches for this part of the surgery.

To summarize you would look great with some subtle, natural looking improvements that could be achieved through out patient surgery.  Of course you would need a consultation with a cosmetic surgeon who is experienced with eyelids to help you decide what procedure might be best for you. 

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Lower Eyelid Procedure best option

Thank you for your pictures.  A lower blepharoplasty is an excellent option.  As we age, our skin both descends and loses fat.  The best option at times is to tighten the skin and inject some fat in order to restore some useful contour.  This is a very reliable and satisfying procedure.  Its important to pick an board certified plastic surgeon who specializes in procedures of the eye.  Best of luck to you!  Dr. Pacella

Salvatore Pacella, MD, MBA, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 33 reviews

Eyelid bags and facial asymmetry

What you decide to do depends on how invasive & costly the treatments are and how much certain things bother you.  Minimizing the appearance of the bags can be accomplished with filler alone injected into the tear trough (the hollow under the bags), which will also give you more definition to your cheeks.  A laser treatment can help with fine lines and wrinkles under your eyes.  

If a more permanent, invasive solution is something you are interested in, a blepharoplasty and repositioning of the outer part of the left eye is a good option - this can correct the tear trough, skin, and eyelid position at the same time.  Your best bet is to see a board-certified plastic surgeon in your area and discuss your options after a thorough examination.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 11 reviews

Best Treatment for Under Eye Bags

Thank you for the great question and the photos. With the eyelid issues you are describing, a lower eyelid lift may be a great option. In my practice, I use an extended approach with fat transposition. This technique uses the fat bags that are already under the eyes to fill in the hollow areas between the eyelid and the upper cheek. Then, the midface tissue is elevated and the excess eyelid skin is removed.  The combined effect is a natural-appearing rejuvenation of the whole lower eyelid and cheek region. Best of luck moving forward!
 

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 106 reviews

Best treatment for under eye bags

 At 33 years of age the best treatment for lower eyelid bags is a trans-conjunctival approach for a conservative removal of the 3  Fatty deposits in the lower lids. The photograph also shows slight ptosis on the patient's left side which may need to be addressed by an oculoplastic surgeon.  For many examples, please see the link below to our eyelid surgery photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 137 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.