Under eye bags, under eye circles, lines, wrinkles, premature aging. And or loss of collagen? (photo)

I am 21 years old and I have really bad under eye bags and puffiness and I guess you could say signs of aging and wrinkling... I've notice this issue for the past year and it seems to be getting more noticeable even with concealing and foundation trying to hide it. Should I look into some sort of surgical treatment, or is this some sort of product that might help some before deciding to go under the knife at such a young age?

Doctor Answers 4

Undereye bags and wrinkles

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I think you look fine. I'm not recommending surgery but it is an option.
Fillers are OK but you can expect bruising and they are temporary. Fillers are not without complications. Dysport has been useful to treat wrinkles and may be useful to maintain your skin even after surgery.The best surgery I can do for your problem is transconjunctival blepharoplasty with periocular skin resurfacing.  I've been doing them for over twenty years with mostly satisfied patients. One class of patients, those with body dysmorphic syndrome (think Michael Jackson), can only be satisfied half the time even with excellent results. 
If you have fillers placed around your eyes make sure a cannula (not a needle) is used and your doctor is experienced with them.
Have a small laser test done a month before the CO2 laser to ensure you are a good candidate and your skin won't whiten too much.
Avoid a lower blepharoplasty where there is a cut placed thru the skin and orbital septum so you don't risk downward pulling of the lower eyelid.

Honolulu Dermatologist
5.0 out of 5 stars 5 reviews

Don't rush into surgery

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Hi Cassie,

My initial impression was also to recommend a small amount of filler to hide your very small under eyebags, but I am not completely convince it is the right procedure for you.  When I take an eyelid photo series, I will take close ups of the eyes looking straight ahead, then looking upwards (which will accentuate and eye bags which might not be visible looking straight, then looking downwards to look for any excess skin on the upper eyelids or any hollowing.

In the more recent photo, it appears that your chin is down more and your eyes are looking more sharply up.  This can cause the eyebags to look particularly bad in this position.  If the patient is having lower eyelid surgery under local anesthesia, we may even ask the patient to look upwards when removing some fat to help push the fat out more. or make sure it looks smooth even when the patient is looking upwards.  

I will include a web reference link from my website showing an example of lower eyelid fillers treating a moderate/severe lower eyelid bag, and you will hopefully appreciate that if the cheek and lower eyelid is blended seamlessly with a very small amount of filler such as Restylane (as little as 0.5 cc up to 2 cc's)  The patient in the web reference link used 1.5 cc of Restylane.

The skin wrinkling and fine lines may be due to cumulative sun exposure.  I had a 31 year old young man come in one day when he noticed crow's feet and fine lines around his eyes.  He knew he had sunbathed too much in his youth and he wanted to reverse some of these aging changes.  I placed him on Obagi Nu-derm with Retin-A and Obagi Elastiderm Day Eye cream.  He has been on this regiment for about 3 years.  He is much more careful about sun exposure and never goes out without sun screen.  

The fact that you are using a bronzer perhaps indicated that you like the tan look and perhaps had significant sun exposure in the past several years?  If so you can still protect your skin and try to reverse of some of the sun damage.

I agree with Dr. Steinsapir's title of "Less is more."  There is no reason to go crazy with fillers.  Small amounts of filler which is artfully injected does not always require huge volumes to accomplish the desired goals.

If your eyelid series photos showed a true eyebag, then you may still be a candidate for a lower eyelid fat removal.  One note of precaution, transconjunctival fat removal alone can potentially increase the lower eyelid wrinkles.  Please consult with a board certified facial plastic, occuloplastic or general plastic surgeon to evaluate both surgical and non-surgical option..  If you plan to go skincare and injectables only, then you can also see dermatologist.


Dr. Yang

George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Less is more.

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Do not squander what is working for you.  The challenge for you will be finding an honest, straight forward cosmetic surgeon.  You best options are non-surgical.  You will do great with under eye filler but you need to find the right injector.  This is both an art and a science.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Correcting Early Facial Aging Without Surgery

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Hi Cassie,

The cahnges that yoiu are seeing in your face are part of the natural course of aging.  Ealry in life, usually in our late teens, we start loosing fat around what doctors call the "periorbita," or the area around the eyes.  Because of this fat loss and decent, we start seeing bags under our eyes and a less happy or tired look.  At the same time the lower third of our faces becomes more heavy.  Although many go straight for blepharoplasty surgery, This is not the correct initial solution in my opinion.  the best solution is replacing the lost soft tissue in shapes that appear youthful and happy.  In my practice I call this "Aesthetic Facial Balancing."  I use high quality hyaluronic acid products such as Perlane or the bodies own natural fat.  The most important part of this is not what filler is used but rather the aesthetic judgement of the person placing the fillers.  However all fillers besides hyaluronic acid and autologous fat should be avoided because they actually cause further fat atrophy, facial scarring and further facial aging.  The concept is to restore volume in a manner that leaves no stigmata of intervention.  I even did this to myself in a minidocumentary on YouTube.

Thoughtful placement of hyaluronic acid fillers will restore and balance your face and if done properly will deliver a more natural and beautiful result than even a perfect blepharoplasty.

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.