Are eye bags and fat deposits the same thing? (photos)

The answer to your question may seem confusing, however, the bags under
your eyes are caused by bulging fat in your lower eyelids. For these to be treated, they must be
removed. An incision will be made inside
the eyelid, called a Transconjuctival incision, and the fat pockets removed
(referred to as a lower lid blepharoplasty).
This would be the best approach for your particular case, and could give
you a very pleasing result by taking away the bags under your eyes. However, it does appear that you have a
flattened cheek, as well. A filler would
provide an excellent enhancement for this area.
The combination of a blepharoplasty, along with fillers to add volume to
the cheeks, is commonly used in my practice when treating patients with a
similar situation.

From the pictures, it does appear that you have herniated fat under your eyes. A conservative reduction of that fat is necessary to improve that. A well trained surgeon will not over excise the fat, so you don't have to worry abour being hollow. In addition to reducing the fatty bags, for the best result you should have something injected into the crease underneath the bags at the same time. That way you have the best chance at a nice, smooth lower eyelid/cheek complex. We usually don't use Radiesse for this as the eyelid skin is very thin. A fat injection works nicely for this area.

You have gotten three opinions, two of which are valid.  To answser your initial question, the fullness that you see in your lower eyelids is in fact fat.  The eye floats in a bed of fat.  The fat is held in place by a thin layer of tissue called the orbital septum.  As we age, like all other tissue in the body, the orbital septum begins to thin and weaken, and the weight of the eyeball on top of the fat pushes the fat against a thin septum which results in lower eyelid bags, or fat herniation.  The problem you have can be corrected to a point with injections of Restylane or fat.  Filler injections serve to merely camouflage the hollow around the bulges by filling up the hollows of the lower eyelids.  The procedure is safe and will last for over a year.  Depending upon your age, lower eyelid surgery which repositions the lower eyelid fat and minimally removes the fat will yield the best long term results and will not leave you with a hollow appearance you have been told can occur. 

I greatly appreciate the pictures. It appears that you have some fat beneath your right lower eyelid and minimal fat below the left lower eyelid.  I definitely would not recommend Radiesse or any other filler in that area. Only a physical examination would determine if surgery is appropriate.

Lower lid bags are typically caused by accumulation of herniated orbital fat.  This condition is surgically treated with lower blepharoplasty.  In patients with mild herniation, dermal fillers such as Belotero, can be used to fill around the area allowing the lower lid to appear smoother.  This procedure is popular for many who wish to avoid surgery.  Volume loss, causing a tear trough deformity, can also give the illusion of lower lid fullness.  This condition can also be addressed non-surgically with fillers.  I would not suggest using Radiesse in the lower lid region, this filler can lead to contour irregularities in this delicate area.  I would suggest consultation with a board certified surgeon specializing in facial rejuvenation to go over all your options, minimally invasive and surgical. Good Luck!

The different answers are all actually correct, depending on what your goals are. Your right eye certainly would benefit from a lower lid blepharoplasty.  Fillers or fat grafting into the tear trough would be helpful for reducing the bag completely. The left eye might do well with just filler alone but could also be improved from a lower eyelid blepharoplasty. I would recommend the surgery, as it is a permanent solution to the problem for you.

 The photograph demonstrates some herniation of the fat pads  And a tear trough abnormality. a filler can help somewhat but a lower lid blepharoplasty the translocate some of the medial fat into the tear trough will leave an excellent in permanent result.

Fat in the lower eyelid can cause eye bags, but not all eye bags may be due to fat.  In most cases, lower eyelid bags are due to fat.  This issue can be dealt with surgically, but it is possible to use fillers the treat just below the bag to help camouflage it and improve the appearance.  I would not recommend using Radiesse on the lower eyelids because it is a fairly firm product and may produce some unevenness.  I would recommend using one of the hyaluronic acid fillers, like Restylane, under the eyes because it is a gel and tends to give more uniform results.  

Looking at your photos, I have observed that you have lower eyelid fat
prolapse. Lower eyelid fat prolapse means that the fat pockets normally around
your eyes have pushed forward. In MRI studies, there is an increase in volume which
is called herniated fat.



The concerns about how to approach this and its consequences are becoming
more confusing these days. There are a lot of options suggested by different
doctors as treatments for under eye bags. There are people like myself who tend
to advocate more definitive solutions like surgery. However, eyelid surgery is
not a generic procedure. There are two types of approaches: one is
transcutaneous which is from outside of the eyelid and the other is
transconjunctival. In a case like yours, I would typically do transconjunctival
blepharoplasty. This is a technique where I work at the fat pockets from the
inside of the eyelids, performed under local anesthesia with LITE™
sedation. This reduces and repositions as is appropriate so it looks like you
never had the fat pockets there.



With this procedure, the concern
about hollowing becomes an issue. Hollowing is often perceived when someone’s
eyelids are pulled downward and that is really what scares a lot of people.
This situation is called lower eyelid retraction. As a specialist in this area,
I see a lot of patients from all over the world to correct lower eyelid
retraction and to help them look as if they are not as hollowed. In addition,
with facial aging, there is volume loss in the cheek area below the bags look
flat. The solutions for that are Radiesse, Restylane, fat,
or cheek implants. I suggest to not put so much volume to camouflage the fat
pockets. I have patients who got over puffed and they look unrecognizable or
unnatural. I end up using an enzyme like hyaluronidase to actually dissolve the
fillers.



I think you need to try to narrow your decision and try to figure out which
doctor resonates with you and you feel comfortable with. Otherwise, meet with
the additional doctors. From my perspective as a 20-year cosmetic oculofacial
plastic surgeon, transconjunctival blepharoplasty most likely would be starting
point for you to address the dominant feature on your face. I hope that was
helpful, I wish you the best of luck, and thank you for your question.



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All answers from the various plastic surgeons can be valid. Treatment of the lower eyelid and cheek areas probably have the most variability among plastic surgeons. There isn't one "best" answer to improve the lower eyelid area. Generally, there is plastic surgery and/or facial filler to potentially improve the lower eyelid area or bags. Surgery often will remove and/or reposition fat and tighten the skin and muscle. Facial fillers (ex. Restylane) help restore lost fat volume to smooth the appearance of the eye bag. None of the treatments are necessary, as cosmetic procedures are elective to improve one's appearance. Continue doing your research then speak with your plastic surgeon again as you decide on how to proceed. One option to consider is to start with filler, then later proceed with eyelid surgery as needed.Best,Dr. Chaboki