Under Eye Bags; Fluid Retention? Fat?

I am a 28 year old male and as the picture shows, I have fairly prominent eye bags that I have been trying to find a way to correct. I went to a Dr. and she said that there not caused by fat hernation, as I had previously thought, as that seems to be the most common cause of eye bags, but some sort of fluid retention. What solutions are available for eye bags that are due to fluid retention and not fat? What might be causing this problem in the first place? Thanks for your help!

Doctor Answers 20

Eye bags are caused by a variety of things.

These are not caused by fluid retention.  What we are looking at is the bone of the orbital rim draped by the thin lower eyelid tissue.  You have a very prominent midface groove extending from the corner of the eye out to the side of the face.  What you are missing is deep facial fat in the buccal fat space that helps to support this area.  The best treatment for this is not lower eyelid surgery or midface lifting.  The best treatment is non-surgical in the form of hyaluronic acid fillers, specifically treatment with Restylane and Perlane.  The treatment will last 1-2 years provide you get enough volume.  You need to find a surgeon who does a lot of this sort of treatment.  The liquid face lift website might help you identify someone in your area who can help you with this.


Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Treatment Plan

From the photograph, it appears you have lost substantial mid-facial tissue, but also have a slight bulging of lower fat pads. Performing a lower eyelid blepharoplasty with only a small amount of fat removal as well as placing filler in the periorbital region would most likely be the treatment of choice. It is difficult to make the accurate decision without evaluating your face in person; you should seek a consultation for an appropriate treatment plan.

I hope you find this helpful.

Hands on examination is necessary.

It is often obvious in a photo to determine the source of the bulginess in the eyelid. In your case, however, I feel its difficult without visualizing the skin surface, and the palpating the give of the tissues, to properly address "fat or fluid".

Although the culprit seems to mainly be lack of midface fat which exposes the orbital fat, some degree of fluid retention cannot be ruled out by this photo.

I would recommend an in person consultation with a surgeon with expertise in surgery and fillers.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 33 reviews

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Are my under eye bags fat or fluid retention?

I have performed eye lifts for over 20 years and lower eyelid bags are caused by:

  1. Fat tissue
  2. Malar bags

 Examination and palpation of the location of the bags will help identify the likely source of your bags.  If you press on the bags and you feel a give, in the tissue, you are inside the eye socket and the bags are most likely fat which can be reduced with a lower eye lift or eyelid surgery.  If, on the other hand, when you press on the bag you feel bone of the lower eye socket or cheek, these are what's called "malar bags."  Malar bags are caused by chronic fluid retention, or swelling and will not be reduced with eyelid surgery.

 Malar bags are caused by fluid retention and are genetic in nature.  Lowering salt content in diet can sometimes help reduce these bags.  Soft tissue fillers like Restylane, Juvederm and Perlane can help featrher the edges of the malar bags making them less obvious.  The only surgical option, that I have fould useful in eliminating malar bags is the placement of Cheek Implants, in appropriate candidates. 

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Options for Under-Eye Bags

There is a variety of possible causes for water retention, including

diet, allergies, and genetics, so consult your doctor about your
overall health and likely causes. Afterwards, see a certified,
experienced plastic surgeon in person - and seek a second opinion. The best solution for under-eye bags is usually blepharoplasty (eyelid surgery), which involves removing excess skin from around the eyes. However, as you are still young, you may wish to consider injectable fillers. We find them extremely popular for those not yet ready for blepharoplasty, and fillers can also add volume to your face.

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 113 reviews

Eye Bag Treatment

Thank you for your question and providing a photo.  From what I can see in your photo it looks like you have less fat in your cheeks then is typical for a 28-year-old. Notice the indentations going from bags and heading downward and outward on your cheeks?  This may just be a family trait.  Loss of fat in the face can also be present in certain medical conditions, however you would know that you had that type of a problem before you noticed the changes in your face.  The bottom line is that I suspect that you would benefit from some filler, like Voluma, in your cheeks.   RealSelf is helpful, but it is not a substitution for a face to face consultation with your cosmetic surgeon. 

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Lower eyelid solutions

Swelling in the undereye area can definitely be contributed to by uncontrolled allergies and alcohol consumption.Making sure all allergies and external causes of swelling (alcohol intake, etc) are addressed prior to any interventions you elect is important. After these have been accounted for, you may very well benefit from transconjunctival fat excision , skin excision (traditional lower eyelid blepharoplasty) and midface fat grafting to achieve a greatly improved look.
Best of luck in reaching your goals

Eye Bags

Thank you for posting your pictures. Two main issues: bulging lower lid bags, and significant volume loss in the midface. Lowr blepharoplasty with fat transposition and mid face lift via same lower lid incision will give you a more youthful appereance. Hope this was helpful. Good luck!

Eye Treatments for Bags

Best way to determine the etiology is with an in person exam but it appears you have a combination of issues.  You seem to have some degree of lower lid fat prolapse, you have a deep tear trough, and your mid-face (cheek region) appears to be deflated.  Sometimes some filler/fat in the tear trough cheek areas help enough at a young age.  It depends on the degree of the problem.  Sometimes a combination of treatments works best.  Find someone you trust who is proficient in both surgery and filler and get their opion.  GOod Luck!

Under Eye Bags

Puffiness under the eyes that comes and goes can be the result of water retention. Start by reducing your salt intake—and take a good look at the skin products you’re using around your eyes. Gels have a high water content, which might be contributing to the puffiness. Your best bet might be to use lightweight creams or serums, which absorb quickly. If your puffiness doesn’t go away, don’t hesitate to contact us to book an appointment; there might be another cause of the puffiness that can easily be treated in office.

Dennis Gross, MD
New York Dermatologist
4.4 out of 5 stars 5 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.