Under eye bag and red in color plus dark circles. Is there a solution other than surgery? (Photo)

Thank you for your question. You are describe dealing with under eye puffy areas that are reddish in color, and dark circles. You have tried some remedies that were recommended in the internet, and met with a doctor who said the only solution is surgery, and this is a hereditary problem. You are also questioning why you don't see anybody in your immediate family with these problems, and if there is a solution without surgery.
I can help you with this question as I discuss this issue with my patients every day in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Helping people with under eye bags and discolorations both surgically and non-surgically have been the core of my practice for several decades. I can also help you understand a little about the genetics and heredity.
We always assume we are products of just two parents, but reality is genes are passed through generations. Sometimes one particular gene or set of genes are responsible for this condition called lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat normally around the eyes pushes forward, and creates a hernia, and that’s why it’s referred to as herniated fat. The reason why these remedies did not work is that fat has a lot of volume. You are in good company as a lot of my patients come in having gone to every department store and retailer, bought all kinds of creams, and found them ineffective.
There are options in approaching patients who have a little lower eyelid fat prolapse. In the absence of a physical exam and other angles of the appearance of your eyes, I basically break it down to you in two approaches. The first approach is often what people want is minimally invasive because everyone is afraid of the word surgery. When someone has a mild amount of fat prolapse, it’s not a solution but rather a camouflage approach where we use an under eye filler such as Restylane or Juvederm from the hyaluronic acid family. We place it at the level in an area called the tear trough to blend the area of the prolapse with the bone structure. The limitation of this is the relative projection or prolapse of the fat. If somebody has prominent under eye bags, and I suspect looking at your photos you may fall into this category, then surgery is a treatment of choice. In my practice, I routinely perform this procedure called a transconjunctival blepharoplasty where the fat pockets are approached from the inside of the eyelid, reduced, and repositioned as appropriate, which is a highly effective procedure.
For patients like yourself who want to avoid surgery, what we do is perform surgery in our own facility within our practice, which equivalent to doing it in a hospital or surgery center as we are certified by the Joint Commission. This is very important for a lot of patients because they want to maximize safety. Further, the technique and approach is so minimal, so in a way going into my office for an injectable filler or having a surgery are almost the same, with the only difference is you’re in the operating room and get a little sedation. The procedure is as minimally invasive as one can get, and still address the problem definitively. It’s done from the inside of the eyelid so there are no external scars, and the anatomy of the eyelid is maintained.
Responding to the question about the redness and the dark circles, for your skin type, we have had a lot of success using platelet-rich plasma (PRP). Platelet-rich plasma is derived from your own blood, and we do it routinely in combination with the surgery. We take the wound healing and growth factors from your blood, separate them, and inject them under the skin,  as well as in the space where the surgery is done. We have found this very useful to help our patients with dark circle issues. Further beyond the surgery, it’s something a lot of patients choose to do as maintenance to optimize the appearance of their skin. It’s a choice you make depending on how things look, and how important it is to you to manage the dark circles. So one approach is to deal with the fat pockets, the other is to deal with the skin.
There’s always different lasers and other things that are continuously available and evolving to help us further improve the outcomes for our patients. Combining procedures is often a great strategy to get the best aesthetic result.
Meet with qualified, experienced cosmetic surgeons who do a lot of eyelid surgery to learn about your options. Learn about platelet-rich plasma (PRP), and I think it is in our best interest to choose the procedure that will give you the more definitive outcome in a way you’re comfortable, rather than continuously chasing approaches like the home remedies, or other remedies that haven't been so effective. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Hi enbuti1,Your case is not rare. In fact, tear trough problems such as this is common even among those in their mid-twenties. It may be genetic, a lifestyle issue or some unknown cause. We've seen great results (minimal swelling) with Restylane Refyne injected into the eye troughs to add volume. This hyaluronic acid filler can help diminish the dark circles, but if it doesn't, lasers will help.All the best,Justin Harper, M.D.