I am most concerned with my under eye bags. Any suggestions? (photos)

I had one vile of restylane, which she said I would need two. The one resulted in about a 20% improvement. My question is, is there anything else besides spending $1600 on two viles of restylane, which I can't really afford, that could help with my under eye area?

Doctor Answers 8

Under Eye Bags and Non-Surgical Treatment

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Restylane injections are one way to camouflage bags under the eyes.  Unfortunately it is not permanent like surgery.  A great deal of the darkness is genetic.  Sometimes creams, micro needling, and lasers can improve this area as well.  Best, Dr. Green

Options for Under Eye Bags

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Dear adrian_dilley: 

Thanks for sharing your photo! 

Fillers for under eye bags are a reasonable camouflage approach as they will not physically improve the structural changes which I see in your photo. 

Whereas surgical options may give you the best and longest lasting results, I appreciate the concern for budget. Below are other options to discuss with a Board Certified, Plastic Surgeon or Facial ENT or Dermatologist to improve skin firming and tightening. 

Facial wrinkles and folds are created from 4 different layers of the skin, fat and muscle. 

1. The top layer or stratum corneum of the epidermis is the rough, pigmented layer of the skin; creating most of the depth of the wrinkle. 

Exfoliation is best for this using 
  • microdermabrasion, 
  • Retin-A (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper epidermis, 
  • some lasers and chemical peels. 

2 The second layer is the dermis which thins with aging. The natural collagen, elastin and hyaluronic acid (which hydrate and toughen the skin) are thickened by the use of: 
  • fillers (Restylane and Juvederm), or 
  • Retinoids (ZO Obagi Skin Health System), which also renews and regulates improved function of the deeper dermal skin cells. 
  • Sculptra properly managed is the latest sensation in stimulating firming and thickening of the dermis

3 The next layer or fat also thins or droops with age and maybe:
  • filled (Restylane and Juvederm), fat grafting or 
  • redraped (threadlift, short-scar, traditional, endoscopic face / neck / brow lifts)
4 Finally, the muscle which creases the skin into wrinkles and folds is weakened and rebalanced with Botox or similar injectable muscle relaxers like Dysport or Xeomin. 

In your case, I would recommend you consider a mini-face lift , mid-face lift, and/or lower lid lift.

Everyone needs one or more layered improvement and in personalized combinations to achieve their optimal result.

I hope this has been helpful. Good luck!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

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

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There are many ways t o treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately.   All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.

Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Under eye bags

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Tear troughs can be treated with filler and under eye bags can be treated with surgical excision. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Lower lids

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Adrian_dilley, A "SOOF lift blepharoplasty" in my opinion this the best procedure for improving the puffy/ hollow look under the eyes that accompanies the aging process. I've been doing nothing but this procedure since I originally published this approach around 1999 in the Archives of Facial Plastic. There is a lot of information on the web about this procedure so you can Google it and read all about it. Always lLook at your prospective surgeons photos, lots of them. If he is unable to provide them that is a red flag. . Seek a facial specialist with years of experience and get two to three opinions, look at the doctor’s photos and you'll do alright in most cases.

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

I am most concerned with my under eye bags. Any suggestions?

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Yes there are other options both non surreal and surgical BUT also double the fees!!!!!!..............

Bags under her eyes

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This is one of the most difficult situations to fix.  There are many options and individuals can improve with one option of the other to understand in detail the various options of her likely to read a detailed article from my blog written below.


Dr. J

Dark Circles under the eyes
The dark circles happen from many different reasons. It usually is a contrast between the surrounding pale skin and darker skin of the lower eyelids. The sun shines down from above exposing more of the lower eyelid skin that sits on a platform of the cheeks. This is why the football players put dark grease under the eyes to reduce the glare effect. When you are born skin color is the same for all of the facial skin. After years of sun exposure it starts appearing darker than the surrounding skin. There are a few more contributing factors. Allergies can increase blood supply leading to dark blood causing congestion and dark shiners. Excess fat of the lower eyelid skin can cause a shadow effect and make the dark circles look worst.
In light of the above the treatment depends on the cause. For sun induced darkness lasers and chemical peels help. However, exposure to sun can bring it back. Strict daily application of sun screen and wearing sunglasses is a must.
If you have allergies, then proper use of antihistamines, and nasal steroid sprays under the supervision of a physician or immunotherapy will help.
Lastly if there is fat bulging from the lower eyelids then there are two good options. In cases of small amount of fat, injecting a filler such as Juvederm or Restylane just below the fat bulge in the tear trough will camouflage the bags and hence reduce the dark circles. If there is a lot of fat then lower eyelid blepharoplasty is a viable solution. In this procedure excess fat is excised along with a small amount of excess skin and then lower eyelid becomes relatively flat reducing any appearance of dark circles.

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Under eye bags

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Thanks for your post. It sounds like you are unsatisfied with attempts to disguise your lower eyelid bags with filler injections. The only real way to eliminate the bags is via surgical removal or repositioning during lower eyelid surgery (blepharoplasty).

The advantage of surgery is that the results are long-lasting and natural if performed by an experienced eyelid surgeon (facial plastic, oculoplastic, or plastic). While surgery may cost more than a syringe of filler, the long term costs are much less than serial filler injections. 

I recommend you see an experienced surgeon in your area for an in person examination and to discuss your surgical options. Good luck!

Mark Been, MD
Barrington Facial Plastic Surgeon
5.0 out of 5 stars 13 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.