Weird undereye, procedure recommendations? (Photo)

Hello, I usually refer to these as under eye "rolls" rather than "bags" because they do refer to different issues, which are treated differently. The typical "bags" that most people refer to are the under eye fat pockets that protrude. These are more common with advancing age, but can occur in younger patients as well. One way to know it's fat bags is to look up with your eyes, which makes the fat bags push forward and appear more prevalent. This is different from you are seeing. In your case, the rolls are formed by the skin and muscle under the eye. When you smile, the muscle contracts and creates a roll. I tend to see this with patients that squint a lot or strain their eyes throughout the day, as this tends to increase muscle bulk. My approach for this issue is to place some botox (or other toxin) into the muscle. This allows it to relax and over time even lose some of the bulk. Filler will not help in your case and can only make the situation worse. If toxin doesn't work, surgery is an option but you absolutely must make sure the surgeon is well experienced with eyelids. Have at least 2 -3 consults, and try to include at least one oculoplastic surgeon in that mix. Good luck!

Hi @Enthusiastic39366, thanks you for your question. Uneven creases or asymmetry under the eyes can be a common cosmetic problem. Please find bellow some options that may help address uneven folds under the eyes:

Dermal fillers: Hyaluronic acid-based dermal fillers can be used to add volume and restore symmetry to the under-eye area. The procedure involves injecting small amounts of filler into the area to create a more even appearance. Results can last anywhere from 6-12 months, depending on the product used.

Lower eyelid surgery: In some cases, lower eyelid surgery, also known as lower blepharoplasty, may be recommended to address uneven folds under the eyes. The surgery can remove excess skin, fat, and muscle, and tighten the skin in the under-eye area to create a more even appearance. Recovery can take up to several weeks.

Radiofrequency microneedling: Radiofrequency microneedling is a non-surgical procedure that can be used to tighten and rejuvenate the skin in the under-eye area. The procedure uses tiny needles to create micro-injuries in the skin, which stimulates collagen production and helps to tighten and firm the skin. Results can be seen within a few weeks, and several treatments may be required for optimal results.

It is important to consult with a qualified and experienced aesthetic professional or plastic surgeon to determine the best treatment option for your specific concerns and goals.

Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

At least from the photos provided, it would appear that there is hypertrophy of the under-eye muscles that is giving rise to what has been called "jelly rolls" owing to their resemblence to the bulgy ring shape of a jelly roll candy. If this is so, then a couple of microdroplets of Botox can help to soften the hypertrophy and make the rolls much less prominent. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Based on your pictures, I don’t see the need for treatment or surgical intervention.
You can always have a few in person consultations with plastic surgeons in your community if you’d like.
Best,
Matt Hagstrom, MD