What is the Best Treatment To Address Eyebags?

Im really considering to fix my eyebags since I'm tired of always asked if Im OK..since I always look tired even if I had 8 hrs. sleep and well rested. When Im not smiling...my eyes show a hollow-line under my eyes and I know this can be fixed with the injectibles or silikon 1000. However, when I smile I get this other really puffy eyebags (I call them my 3rd and 4th eyes) ..would surgery the best call for me?

Doctor Answers 5

Best Eyelid Bag treatment Options

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Hi essence1981,

Thank you for your question.

Lower eyelid bag treatment is a common request for plastic surgeons. Generally, two options are available: injections or cosmetic surgery. For most younger patients, facial injections with a hyaluronic acid filler such as Restylane help rejuvenate the area. Traditionally for older patients, cosmetic surgery to help reduce fat bulges and excess skin is required. Age alone, however, does not determine the best option.

Only after a comprehensive evaluation by an eyelid specialist can he/she help determine appropriate options for you. The best option for you may not be the best option for another person. Best of luck.

Dr. Chaboki


Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Lower Eyelid Bags - Surgical Treatment

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When I look at your photos, I too see the bulge immediately below your lower lashes when smiling, and which I also believe is a bulging of your lower eyelid muscles (orbicularis oculi muscles). This is normal, and doesn't need surgical attention.

In addition, however, you also have a second, less obvious bulge lower down which creates the "tired look" you would like to eliminate. This bulge is produced by protruding fat that is easily approached and trimmed through an incision on the back surface of each of your lower eyelids (transconjunctival incision) which is completely hidden. Because your bulge is subtle, only a minimal amount of fat needs to be removed.

If you had taken your photographs with overhead lighting, while gazing upward, this area of protruding fat would have been much more obvious in the photos.

Charles Gruenwald, MD (retired)
Baton Rouge Plastic Surgeon

Treatment of tear troughs and lower eyelid bags

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Lower eyelid bags just under the eyelashes are due to the eyelid muscle bulging. Bulging of the fat occurs further away from the eyelashes. That is because cartilage in the eyelid at the higher level prevents the fat from bulging forward. The muscle sits on top of the cartilage so it is not restrained back by it. In lower eyelid blepharoplasty surgery we routinely thin this muscle. You cannot inject this with botox to treat the issue because of the risk of tearing, ectropion and cornea exposure. Before doing any surgery you need to have your vision checked because diminished visual acuity can lead to chronic squinting which in turn makes the muscle bulge. If that is the case here the best option is eyeglasses or lasik. If the visual acuity is normal you could have the muscle thinned without removal of any skin (since you do not have excess lower eyelid skin). There is a risk of recurrence with continued firing of the muscle after surgery because you cannot remove all of the muscle.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

What is the Best Treatment To Address Eyebags?

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What is the Best Treatment To Address Eyebags?  I have performed eyelid surgery for over 20 years and from your photos you have no fatty eyebags.  The bulges that you see immediate below your eyelashes, that become more pronounced when you smile, are the normal size and shape of the lower eyelid muscles.  You don't need or are you a candidate for lower eyelid surgery of any kind.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

What is the Best Treatment To Address Eyebags?

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There are a few was to go about treating your condition. You have minimal orbital fat protrusion most probably due to laxity of your orbital septum. You could got the minimally invasive route with fillers like Restylane that last up to two years and can give impressive results. If you would like a more permanent solution you could have a transconjunctival eye surgery (incision is with in the eyelid so no visible scar) to either just tighten the septum and conserve the fat (like fixing a hernia) or if there is fat excess you can remove some of the fat. No treatment is better then the other if done properly it really depends on your decision if you want a more invasive or less invasive procedure!!!


Good Luck!

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.