What would be the most effective/natural-appearing treatment for tear troughs/under eye bags in a female in her 30s? (Photo)

I am in my 30s and have worsening under eye year troughs, puffy bags and fine wrinkles under the eyes. I have been researching lower lid blepharoplasty but I'm worried about the significant downtime. I've also seen some pictures where the tear troughs have remained which is what I think may be my main problem. Would a filler be appropriate? Or CO2 laser resurfacing? Does this tend to look natural? I am concerned about looking like I've had "work done," but would like to stop being asked if I'm tired.

Doctor Answers 6

Under eye bags

Given your photos, you probably would best benefit from a lower lid surgery (blepharoplasty).  Fillers are unlikely going to help given the amount of fat prominence you have. Best to see an eyelid surgeon.  Best of luck,

Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 102 reviews

Blepharoplasty with natural results for under eye bags

The best option to treat your under eye bags with lasting natural results is transconjunctival lower blepharoplasty with fat repositioning. It can be done under local anesthesia or conscious sedation. It is stitchless procedure with quick healing. See video and link below.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Tear Trough Treatment

Thank you for sharing your question and photos. The “puffs” you are noticing are due to herniated fat pads, which are very common and often occur as we age. These bags can be temporarily disguised with a hyaluronic acid filler called Restylane. I have had excellent results using the innovative microcannula technique, which reduces risk of swelling, minimizes pain, and is essentially bruise-less. Using this technique, filler can be injected evenly requiring only one needle stick on each side. With regards to a laser treatment option, a resurfacing laser may improve the appearance of the bags but I would not consider it to be an effective treatment for this particular issue. The most effective treatment for this problem is a lower blepharoplasty with fat pad transposition. Although this is a surgical option, the results are very natural looking and the procedure is considered a more permanent treatment. I suggest consulting with a board-certified specialist who can further discuss the best treatment options for you after and in person evaluation. 

Kian Karimi, MD, FACS
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 67 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

This needs surgical removal or fillers, lasers, microneedling/PRP in combination for improvement.  Please see an expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 191 reviews

Can soft tissue fillers camoflage puffy lower eyelids?

thank you for your question.  There are several reasons filler under the eyes.  Hollowness, another is to mask bulges, the third is to help improve fine lines and wrinkles, especially with smiling.  It is difficult to say with certainty whethers fillers alone will provide an optimal aesthetic outcome but it does appear that this may be the case.  You would likely require some treatment in the upper portion of the central face as well as the tear trough area.  I would recommend being injected by a physician who is highly skilled in the treatment of this area as proper administration of product in this region requires both knowledge and finesse.  Best of luck.

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 41 reviews

First all your photos show you looking up.

This exaggerates the fullness of the lower eyelid by forcing the anterior orbital fat forward.  How you appear in normal, straight ahead gaze is much more important.  Unfortunately  you did not provide any views of this.  I suspect that you could avoid lower eyelid surgery and simply have under eye filler for this.  The key is to find a highly experiences injector for this treatment.  You are asking for someone to sculpt your face.  Who does this service makes all the difference.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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.