Treatment for under eye bags. (photo)

I have under eye bags that are quite noticeable in certain light (as in the picture above). Would filler or surgery be the best option? I'm concerned about complications and making the situation worse. Which type of filler or surgery would be better? Would removing the fat or repositioning it be better. I'm worried about lumps or discoloration with filler.

Doctor Answers 9

Lower eyelid bags and eyelid festoons

Dear Denver Patient,
It appears from your photo that you have both puffiness in the lower eyelid region from orbital fat protruding forward and a festoon on your right cheek.
Its best to address both for the most natural result. For the lower lid fullness, surgical options including removing or transposing the fat.For the festoon, I've had success using lasers to improve lower eyelid festoons and malar mounds. 
I hope this was helpful.


Tampa Oculoplastic Surgeon
4.3 out of 5 stars 32 reviews

FILLERS ALONE DISAPPOINTING

Fillers alone likely will be disappointing. A thorough hands on evaluation is mandatory for expert advice and options.  Non-surgical specialists will guide you away from surgery so it is wise to seek master surgeons who will give you, and can deliver, all the options.  

Your photos suggest fat herniation without excess skin.  This would make you a possible candidate for trans-conjunctival blepharoplasty. (removal of fat behind the eyelid). see video below

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.8 out of 5 stars 9 reviews

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

The eyes are best treated with a combination approach of fillers, lasers, microneedling/PRP for improvement. Ultherapy/thermage, venus legacy all do well for swelling or puffiness. I would suggest consulting an expert. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 167 reviews

This particular pattern of lower eyelid fullness is ideally addressed with eyelid surgery.

You have herniate anterior orbital fat.  A transconjunctival arcus marginalis release surgery is idea for this.  The lower eyelid fat is moved as a pedicle graft into the top of the cheek.  If you were dead set against having surgery, you might also be helped with fussy under eye filler treatment.  Do not let anyone graft you with fat for this.  There is no substitute for a personal consultation.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Filler VS Lower Eyelid Surgery

Thank you for your question, however due to the quality of the picture it is very hard to assess.  Filler is a good temporary solution, Judeverm is what most my patients like.  Where lower eyelid surgery (blepharoplasty) is a permanent solution aims to address the bags under the eyes. Excess skin and removal or reshaping of the fat smooth’s the contour between the lower eyelid and the cheeks. Please seek advice from a board certified plastic surgeon who will be able to assess you and advise which route to take.

All The Best!! 

Fillers vs surgery

Not a great photo, but if you have prolapsed fat with a shadow over the tear trough you can go with either filler or surgery.  HA filler such as Restylane will help to smooth out the area so you don't notice the fat as much.  If you don't like the filler, it can be removed with the injection of an enzyme.
Surgery with fat repositioning is another good way to improve the contour here.  IT will move the fat into the tear trough.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

The photo is really not a great photo, but it appears that you may benefit from fillers as well as fat re positioning lower bl.

I would really recommend a better photo of your face. If you have midface deficiency, fillers are the best treatment for you. but if your midface is strong and you only have the puffy lower lids, combination of surgery and fillers are the best. 

Treatment of under eye bags

The two main treatment options of under eye bags would be filler or surgery.  The filler is simpler but the result would be temporary.  In some cases, Restylane in this area can last a year or so.  Surgery will directly address the protruding fat that is causing the bags and give a much longer lasting result.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Filler

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 87 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.