Under Eyes Bags. What Treatment Do You Recommend? (photo)

Hi, I'm a 33 years. Recently my bags have become more and more evident. Due to the aging process+a strenuous physical activity(I'm an athlete), I also lost weight and fat in my face I've seen a surgeon for a possible blepharoplasty and he recommended not to remove the fat, since it is a milder case, but suggested injections of ialuronic acid around the lid. I often read of bad reaction to injections in this area, causing even more puffiness. Would you suggest a conservative blepharo or fillers?

Doctor Answers 17

Surgical vs. Non-surgical lower eyelid rejuvenation

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If you are seeking improvement and rejuvenation of the lower eyelids then there are two methods, surgical and non-surgical. Non surgical improvement consists of soft tissue fillers such as Juvederm. In addition to soft tissue fillers you may consider microablative fractionated CO2 laser treatment such as SmartSkin and SmartXide will help to tighten the skin. These can be performed in combination.  With the degree of puffiness you have of your lower eyelids I would recommend surgery over non-surgical methods.  

Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Under eye bags

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It looks like you would be a great candidate for transconjunctival lower blepharoplasty to remove the excess fatty tissue in your lower eyelids. You might be able to camoflage the excess fat partially with filler injections, but surgery would be a much better option for you. 

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 183 reviews

Under eye bag treatment

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The photos show a significant amount of herniation of all 3 fat pads in the lower lids.  This is best treated with a transconjunctival  lower blepharoplasty.  The procedure takes about 30 minutes to perform under general anesthesia. For other patients similar to you see our eyelid photo gallery  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Eyelid bags

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From your posted photos I think your best bet is suturing the fat in the bulge to the deep cheek fat. That should hide the trough between your eyelids and cheeks as well as soften the bulge. That may be quite difficult to do along the entire course of the trough if you approach it from inside the eyelid.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Transconjunctival blepharoplasty

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Your have prolapsing lower eyelid fat that can be addressed quite nicely with a transconjunctival blepharoplasty to remove the fat conservatively. Fillers such as Juvederm or Restylane can be used to camouflage the bags relatively well, but will require repeat injections every 6-12 months. So cheaper in the short run, but more expensive in the long run.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Many options for lower eyelid bags

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From your pictures, you are a good candidate for a number of options.  I'd recommend trying an injectable filler first - it is a relatively inexpensive and non-permanent way to treat lower eyelid bags in this area, and may give you a result you are pleased with.  If that doesn't give you the result you would like to see, repositioning (not removing) fat from your lower eyelids from the inside (a transconjunctival blepharoplasty) would be my next recommendation.

Hope this helps,

Dr. Hall

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 12 reviews

Transconjunctival Lower Blepharoplasty Is best

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There is no question that a transconjunctival lower blepharoplasty should be done and not injectable fillers. You have congenital fat herniation and fillers will only make your bags look worse. Fillers are good for tear troughs and undereye hollowing but not eye bags due to fat herniation.

Your under eye bags

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You are a great candidate for a CONSERVATIVE transconjuntival lower blepharosplasty. At  33, you don't want over aggressive fat removal as it will become hollow as you age. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 105 reviews

Under eye bags

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 A conservative transconjunctival blepharoplasty just removing some fat and releasing your attachments to the rim will probably be a good solution.  Hyaluronidase will do nothing.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Eye Bags: Juvederm/Restylane injections vs transconjunctival lower lid blepharoplasty

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I'm in agreement with Dr. Rosenblatt. A transconjunctival lower lid blepharoplasty is exactly what I would do in a case such as yours.  Recovery would be very quick (2-3 days), the result would look excellent and you'd avoid all of the risks and/or potential complications associated w/ hyaluronic acid (i.e. Restylane, Juvederm) injected into the orbital rim area.

The advantage of hyaluronic acid is, of course, that it's cheaper. But sometimes, saving a little money in the short run costs you considerably more money in the long run. Injections are not permanent and again, can result in a less than optimal result if not performed by a specialist.

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.