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 23

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.

New York Oculoplastic Surgeon
5.0 out of 5 stars 144 reviews

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 25 reviews

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.

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

Under Eye Bags

The puffiness you are seeing is caused by fat and can be corrected with a transconjunctival blepharoplasty, a procedure that removes a small amount of fat through the inner aspect of the eyes. A fat transplant in to the adjacent outside area (tear trough) may help to even the area as well. This is done at the same time as the inner fat removal.

All the Best, 

Dr. J

A. Dean Jabs M.D., Ph.D.
Board Certified Plastic Surgeon
Bethesda MD/McLean VA

A. Dean Jabs, MD, PhD, FACS
Bethesda Plastic Surgeon
4.9 out of 5 stars 90 reviews

Lower eyelid blepharoplasty

There are many options for lower eyelid concerns, including a blepharoplasty procedure. If you have secondary allergy issues, it would be prudent to seek medical treatment for that condition. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

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 41 reviews

Under Eye Bags and Fillers

It appears from the photo that this are is caused by fat herniating under the eye area and probably needs surgical removal.  I treat a lot of patients with Belotero and Resytlane in the tear trough area to hide this aging and improve the appearance of these bags.  Please consult an expert in this delicate under eye area for the best cosmetic results. Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Lower lid bags can be the result of many factors at play: skin,muscle, and fat!

Let's take a look at your issues one step at a time. First, you are young and have healthy skin. Next, you have a roll just under your lash line--this is thickened eye muscle that is nicely treated with 1-2 units of Botox. Under that you have a crescent of fat. Fat is very sensitive to fluid levels but that is not the cause of your fat prominence--it's just your anatomy. The bags can look larger when you are retaining fluids, but returning to normal fluid status will not make the fat pads go away. The would either need to be removed surgically, or camouflaged with fillers.Under that, you have a prominent orbital bony rim with ligamentous attachments up to the skin. These findings are characteristic of volume loss and/or aging and can accentuate a triangular fat pad seen laterally.

I think you could be treated either with fillers and Botox or surgical fat removal coupled with autologous fat transfer to the lower lids and midface. 

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

Eye bags, circles, and swelling

There are many causes of eye bags. Some are shadow issues (fat, ligaments, skin), some are discoloration issues.  Most people have a multifactorial issue meaning they have more than one problem causing this demarcation. Below is a short list of issues and my treatment process for each. 

1. Prolapsed orbital fat through the orbital septum: You are right this is one of the most common causes. Normally in people in an older age group than you though. It is treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 10 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 151 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.