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 21

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.

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

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 34 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 24 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 9 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 123 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

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.