What procedure would be recommended for under eye bags? (Photo)

I think you would do well with a transconjunctival blepharoplasty with or without laser resurfacing of the lower eyelids to tighten the skin.

Given the fact that you don't want to use fillers, I would suggest a transconjunctival blepharoplasty. Schedule a consultation with a board certified plastic surgeon in your area to discuss.
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Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Thanks for your pictures.  In my opinion, I would recommend a transconjunctival blepharoplasty.  The incision is on the inner aspect of the eyelid. This will allow removal of modest amounts of fat.  I have not heard of the eye cream you mention.  Please consult with s board certified plastic surgeon, oculoplastic surgeon or facial plastic surgeon. 

Thank you for sharing your case with our community.  You are likely a good candidate for one of two procedures and it depends on whether you are ready for surgery or not.  Your first option would be to have a lower eyelid blepharoplasty to remove the bulging fatty tissue from your lids.  Surgery will provide you with a more longlasting and permanent result, but obviously there are certain risks involved.  Another option would be have a filler treatment to your tear trough to mask the bulge and recreate a smooth contour from your eyelids down to your cheeks.  Belotero is a good option and can be performed in the office.  Schedule a consultation with a board certified oculoplastic surgeon with experience in cosmetic surgery and injectable fillers to discuss your concerns.  Good luck!

You may want to talk to a doctor to see if fillers may work for you. Maybe talk to them about Belotero, or what other fillers they recommend. this is something that you do not need surgery for unless it is necessary

Since you are not interested in fillers to help with your under eye bags, I would recommend surgery.  The protruding fat can be addressed with surgery and give you a long lasting result.  I am not familiar with the cream you mentioned, but if the issue bothers you now, I would go ahead and have it addressed soon rather than wait a few years.  

XAF5 seems to show promising preliminary results for non surgical facial reduction. The company which owns it, Topokine®, was recently purchased by Allergan, Inc (the compnay who owns Botox®) and therefore XAF5 has a good chance of obtaining FDA approval ASAP. Wheter it's worth delaying surgery to wait for XAF5's approval all depends on how much your under eye area is bothering you right NOW. No one else can answer that question other than you.

Thank you for posting your photos. Aging changes in the periorbital region can start to manifest early in life contrary to common thinking. It is not rare for me to see patients in my office with similar concerns in their 30's. Fillers are a good option in young people that are looking to camouflage some of the changes present such as tear trough deformity or hollowness at the lid-cheek junction. If the patient is looking for a more permanent solution, surgery might be indicated. In young patients like you, removal of the bulging fat on the lower eyelid could be performed with an incospicous incision inside your eyelid (transconjunctival). The fat may be transposed into the tear trough area to help correct the deformity. If you have excess/wrinkle skin in the lower eyelid then you may need a formal transcutaneous lower blepharoplasty. Hope this was helpful. Good Luck!

Thank you for your question.  I'm not sure what the FDA status is on XAF5 but if approved I don't think that it will be on the market for at least the next 3-5 years.  I'm also not sure if it will replace the results obtained with surgery, but I doubt it.  The "bags" under the eye are caused by pseudoherniation of orbital fat.  The fat that surrounds the eyeball is held in place by a thin sheet of tissue called the orbital septum.  As we age this thin sheet weakens and the fat bulges outward which accounts for the appearance.  This occurs at different times for different people but I believe a good part of when it happens is hereditary.  If you are not interested in a filler to camouflage it, the surgical option is a transconjunctival blepharoplasty in which this fat is removed or repositioned via an incision on the inside of the lower eyelid.  You may also benefit from combining this surgery with fat transfer to the tear trough to address hollowing and/or a lower lid chemical peel to address the fine lower lid skin wrinkles.  Hope that helps!