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

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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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.