What procedure to help my under eye condition/possible eyebags? (Photos)

Question

I do not know if these are eyebags, my anatomy that drops a shadow or discolouration? What are some treatments I could look into?? You could tell that under my eyes it's a big issue I think :(

C. Blake Perry, MD · Answer

Two ways to improve this area. The gold standard would be a lower lid blepharoplasty with fat transposition. This surgery involves an incision on the backside of the eyelid and your natural fat is moved to fill the hollow of the tear trough. This gives you a smooth transition from your lid to cheek without having a “bag.” The other option would be to try and camouflage the bag by adding filler to the midface and cheek. 
Best to see an eyelid expert in your area.

Nima Shemirani, MD · Answer

Hi @Imaginative683471. Thank you for sharing your photos-- you would be a great candidate for a transconjunctival lower blepharoplasty with fat transposition. A lower blepharoplasty will address the herniated fat pads and excess skin under your eyes giving you a more refreshed and rested appearance.

Best of luck,

Dr. Nima

Best of luck,

Dr. Nima

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Donald B. Yoo, MD, FACS · Answer

Common reasons for lower blepharoplasty include tear trough deformity or pseudoherniation of the orbital fat.  An in-person exam would provide a more accurate diagnosis, but preliminarily based on your photos it does appear you have pseudoherniation of fat creating "eye bags.” They should also be more prominent when you look up. Transconjunctival lower blepharoplasty with fat repositioning will provide nice results and a better lid-cheek transition in this case. @drdonyoo

Sam Speron, MD, FACS · Answer

Thank you for your questions and pictures!  A midface lift is also a great option for many people to correct malar bags & usually leads to a more dramatic reduction of lower eyelid fat bags compared to just a blepharoplasty. A blepharoplasty is a good option as well!  The recovery & downtime is very minimal. There are usually no drains, most people can go out the same day. Patients can shower the next day after having a procedure done. Most patients don't take pain medicine. There are never any guarantees of course with any procedure whether it is surgical or nonsurgical in nature.

Surgery is not for everyone. In today's day and age, there are many nonsurgical options to consider although surgery usually gets the most improvement specifically of the malar or lower eye fat bags.  You might also consider a plexr/plasma pen treatment, it targets wrinkles and saggy dull skin.  It is advanced and non-invasive!  Make sure you choose an experienced practitioner that really understands your anatomy.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of mini facelifts and eyelid lifts but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Ayse Dolar Bilge, MD · Answer

Hello , as you have fat bulging, it seems you are a very good candidate for transconjunctival blepharoplasty

A.J. Amadi, MD · Answer

You have classic lower eyelid fat prolapse that can often be hereditary and present at a young age. You would be an excellent candidate for lower blepharoplasty with fat repositioning. This way we can preserve your volume and use it to augment the tear trough hollow below the eyelids "bags". I have included a link to outcomes of similar patients. 
Virtual consultations are available. Good luck!

Kenneth D. Steinsapir, MD · Answer

One can not diagnosis the need for lower eyelid surgery from a photograph or a zoom call. There are more than one cause to lower eyelid bags. Yes some benefit beautifully from lower eyelid surgery. However, some eyebags are not caused by herniated orbital fat and not surprisingly those eyelids do not respond to routine blepharoplasty. You need a physical examination of the lower eyelid to determine the basis for your eyelid bag. You may also have the option of using under eye fillers instead of having a surgery. Fillers are an office service. Your eyes can be your best feature.

Mehryar (Ray) Taban, MD, FACS · Answer

You are likely candidate for lower blepharoplasty but it is important to more detailed evaluation to determine. See an expert.

J. Roberto Ramirez Gavidia, MD, FACS · Answer

Great Question! Blepharoplasty is a surgical procedure that helps treat eyelids, which can be performed on both the upper and lower eyelids. This surgery can help target the eyes by removing skin, muscle, and even fatty tissue. As with any surgery, finding the right candidate for the procedure is imperative. Schedule a consultation to find out if a blepharoplasty is right for you! Best, Dr. RG

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