Do I Have Under Eye-bags or Sunken Cheeks?

Question

i'm desperately looking for under eye-bags-treatments but i think the best treatment is the consequence of a good diagnosis and i am not sure whether i really have under-eye bags or if i can see now the swell that i always had because my cheeks have sunken. I am 29 years-old and i don't have any wrinkles yet. Please, i need your opinion. Thanks in advance!

Larry S. Nichter, MD, MS, FACS · Answer

Almost impossible to answer with this photos and without an exam. Although you can camouflage the problem in certain cases with fillers, a blepharoplasty is generally recommended.
Patients who would benefit from a blepharoplasty include those who experience:
	•	Excessive, sagging, or wrinkled upper or lower eyelid skin.
	•	Excess upper eyelid skin that interferes with vision.
	•	Loss of your natural upper eyelid crease
	•	If you have puffy pouches of fat in the upper or lower lids that create a tired or aged appearance.
	•	Orbital Rim Show: visibility of the bone under the eye sometimes contributing to a dark ring or shadowing.
Normally, everyone has a small amount of fat around the eyes. If the quantity of fat increases or the local tissues stretch and weaken, the fat begins to bulge producing “bags.” Occasionally this bulging is seen in young patients and is an inherited family trait, and not a result of aging. These changes have a profound effect on one’s appearance giving a tired or haggard appearance. An attractive face with these early signs of aging can affect a patient’s self-image, attitude and sense of well-being.

Peter A. Aldea, MD · Answer

Regarding: "..not sure whether i really have under-eye bags or ...my cheeks have sunken"

	The answer is BOTH.

	Normal aging is associated with downward sagging of the cheeks resulting in:
	- a taller lower lid
	- unveiling of the inferior rim of the orbit creating the Tear Trough line
	- pulling out the fat under the eyeball resulting in bagginess of the lower lid.

	SOLUTIONS

	1. Simplest - fill the Tear Trough depression with Juvederm. This will make the line much smoother or go away.

	2.  More involved - Laser resurfacing of the lower lid with a fractional device such as the SCITON Joule ProFractional capacity. This will tighten the lower lid skin and can be later further improved by placing Restylane along the fold smoothing it.

	3. More involved - Transconjunctival Blepharoplasty removing the prominent fat bags with or without laser resurfacing of the front skin or placement of Restylane

	4. Most involved - Vertical mid-face lift, lifting the sagging cheek to its youthful position with a Skin Pinch removal of the extra lower lid skin.

	Good Luck.

	Dr. Aldea

Do I Have Under Eye-bags or Sunken Cheeks?

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