Is Blepharoplasty the Only Solution for my Eye Bags?

Are Fractional CO2 laser treatments effective for under eye bags? Do fillers work better or is surgery really the only option?

Doctor Answers 22

Lower eyelid bags

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Surgery is never the only option. We typically see blepharoplasty as the gold standard to compare against. Although these options may help your eyelids temporarily - which is to say, yes, they will help smooth things out a bit - I believe that you are really looking for the results that a blepharoplasty can deliver. You have a fairly significant group of aging stigma. The surgery will give you your best option but the alternatives may provide some nice temporary benefits. The best solution in my hands for your eyes may be some juvederm in the lower lid creases and botox in the crow's feet area with fraxel to resurface the skin.

Best of luck,


Dallas Plastic Surgeon
4.9 out of 5 stars 125 reviews

Correction of lower eyelid bags: surgery, fillers, peels, etc.

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I don't see a role for laser here. Depending on the specific anatomy, I usually prefer a transconjunctival (inside the eyelid) approach to the fat, combined with a skin pinch removal of the excess skin. Once this has healed, fine texturing of the skin can be improved with a chemical peel (I favor Jessner's + TCA). Juvederm can also be used to fill in any tear-trough depression below the eyes. Sometimes I utilize all of these techniques, sometimes only a few.

From the photo, though, most of the improvement would be with the blepharoplasty (the surgery). It's also one of the least expensive surgical procedures and quickly rivals what can be done with fillers in terms of cost.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Solution for fat bags below the eyes

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Fat bags below the eyes can't be reduced optimally by lasers or transcutaneous procedures.

Fillers can temporarily reduce the appearance of the bulges by augmenting the areas around them, but your bulges seem quite prominent and would be best served by a surgical solution.

For straightforward reduction in the fat, a transconjunctival blepharoplasty with laser resurfacing may bn acceptable option.

For an even better result, you may be a candidate to reduce and reposition your fat, and perform an ultrashort incision cheeklift to reduce skin looseness below the lower eyelids.

Several consultations with reputable plastic surgeons should guide your decision.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Options for lower eyelid rejuvenation

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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 with fat repositioning.  An accurate diagnosis of the problem is essential.  .  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.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Lower blepharoplasty is best solution for eye bags

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Fractional CO2 laser treatments are not effective for lower lid eye bags and are only effective for freckles, skin discoloration, and fine lines. Fillers are not a good option around the eyelids. If the filler is placed in the wrong anatomical area and into the orbital septum, it can remain there for years on end, and it gives it the look of having a puffy eyelid for years. The lower blepharoplasty through a transconjunctival approach removes the fat bags that are present on the lower lids, and a pinch of skin can be done at the lash line if necessary.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

So many options for eye bags

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You have many posts to your questions and as you can see there are various ways to improve the area around your eyes. The best way to determine your options is to visit with a surgeon to evaluate the quality of your skin the amount of fat protrusion, the tightness of your lower eyelid, the function and position of your upper eyelid and the position of your brows just to name a few critical pieces of the evaluation.

Your picture gives does not give me your complete story. Based on this single shot you have some laxity to the lower eyelid skin and protrusion of fat as well as some wrinkles (crow's feet). This combination is best treated with blepharoplasty to address the areas that are at issue. Fillers are great in my mind to blur (fill) a distinct groove between the eyelid and cheek in a patient that otherwise has no other issues.

Visit several surgeons in your area to get the last word on the matter.

Good Luck!


Eye bags and surgery

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From your photo, I believe that you could be a good candidate for fillers. If you want to try something long lasting but not permanent, Juvederm is a good option and can last up to a year. If you want something more permanent, using your own fat as a filler is a good option if you have it done by an experienced Plastic Surgeon. The CO2 laser would be "icing on the cake" so to speak, in that it will smooth the wrinkles and give a better texture and appearance, but laser resurfacing only treates the skin, not the bags.

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
4.9 out of 5 stars 109 reviews


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It is difficult to determine if there is a best option, as every individual is different. I would really need to see additional photos and examine you in person to help advise you on what procedure would benefit you the most. If fat is present, fat repositioning is a great option. Please take a look at the videos on my website for a demonstration, and feel free to contact my office. Thank you and best of luck.

Dr. Nassif

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Procedures for eye bags

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Thank you for your question!

While your picture helped, I would need to examine you to give you the best advice. The best thing to do would be to find a board certified plastic surgeon who specializes in this area, that you are comfortable with, and listen to your options.

Generally speaking though, blepharoplasty is not the only solution for your bags. It all depends on your expectations and what you want changed. There are many procedures such as laser treatments and fillers that can aid in rejuvenating the skin and decreasing the appearance of wrinkles as the other doctors have noted already. Sometimes, it is best to try all of your options before surgery. However, with bags, it is generally fat, excess skin and issues with muscles, so laser treatments and fillers won't be your best option. In which case, there are several surgical procedures that produce very nice results.

Best regards,

Dr. Speron

Sam Speron, MD
Chicago Plastic Surgeon

Eye Bag Correction

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Your eyes demonstrate skin excess / laxity, prominence of lower lid fat and a deepening tear trough .

In my opinion, while surgery COULD be done, you may get a nice result with Sciton's ProFractional treatment combined with their SkinTyte BBL. That should nicely tighten the skin and placement of Restylane along the Nasojugal line would nicely improve this feature. If you are happy with the improvement so far, I would stop there. If you want further improvement, a Transconjunctival Blepharoplasty (Eyelid Job) would smooth away the fat bags.

Good Luck.

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

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.