What are my option to get rid of deep under eye creases/bags? (Photo)

Thank you for your question and sharing your photo. Based on the photo it appears as though you have a prominent eye bag that is accentuating the deep trough trough below.  There are surgical and non-surgical options for this.  Lower Blepharoplasty is a surgical procedure where the fat pad is removed from under the eye and in some cases transpositioned to the hollow area below.  Being that you are only 25 years old, perhaps a non-surgical approach would be more appropriate. Injecting filler directly below the eye bag into the tear trough will blend the area and give you a more youthful appearance. 

Thank you for your question. You submitted a single photo, state you’re 25, and always had under eye bags, so you’re looking for a way to address these issues. You’re asking about creams and other options.
I can give you my perspective as a specialist. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I’ve dealt with a lot of patients with exactly this type of situation. Under eye bags is probably the most common surgical procedure we perform in our practice.
It is extremely common for a person like yourself to say they’ve always had under eye bags. In fact, people who come to me in their 30s and 40s will say that they’ve had under eye bags since their teens. So what is the best way to treat these under eye bags?
In the past several years, the options have become using a filler versus doing something surgical, and I perform both in my practice. Fillers are perceived as less invasive, but you’re still going through the skin, so in my mind it’s no different from surgery. Fillers can be effective in softening the transition between the deep area of the tear trough relative to the under eye bag.
With eye bags, it’s important to understand the anatomy to understand the principles of the solutions. Under eye bags represent lower eyelid fat prolapse, meaning the forward movement or shifting of fat that’s under the eyes. This is something you’ve always had, so it’s not age-related, but anatomic. The solutions are either soften the appearance, or surgically reduce the fat pockets.
At 25, you may feel you’re too young for this procedure. The reality is there are plenty of patients I have operated on your age and younger. The problem is significant enough for an intervention. In my opinion, it is less practical for a 25-year-old to keep going to a doctor’s office to keep getting injectables if there is an alternative long-term, more definitive solution. Based on just the photo and not a physical examination, I would lean towards a surgical procedure called transconjunctival blepharoplasty. That means under local anesthesia with LITE™ sedation, I would address the fat pockets from the inside of the eyelid. I would reduce, dissect, remove, as well as reposition as appropriate so you look as if you never had the under eye bags. This procedure works very well and can last a very long time, particularly when you do it this young in your life. It will more definitively deal with the anatomy of your issue.
Now something to, as a side note, a lot of times when people have this type of issue, they also happen to have relative hollowing of the cheek area and it’s something that I point out and it’s not hollowing in terms of aging but more of hollowing just as a matter of anatomy.  I also discuss the options of augmentation of these areas, but it does bring us back to considering fillers and other things.
Often with the lower eyelid blepharoplasty, I will combine PRP to help improve skin quality and discolorations, and maybe improve some volume in this area. PRP is platelet-rich plasma which is derived from your own blood, which is routine for us to do this at the same time as the procedure to maximize the aesthetic outcome as we’re taking away the fat pockets, but also improving skin quality.
Often, I suggest to my patients is do the procedure, then see how you look afterwards. If anything draws your attention, then we can consider procedures to help further maximize your appearance. Based on this photo, I would lean towards lower eyelid blepharoplasty. In our practice, we perform these procedures in a Joint Commission certified facility, which is the same certifying body that certifies hospitals and surgery centers. We’re able to provide the safety and the standards of quality, but at the same time, do it at the office setting under local anesthesia with LITE™ sedation.
I think it’s important for you to meet with qualified, experienced cosmetic surgeons. Look at their results and level of experience doing this type of procedure. If you like the outcomes, I think you’re more likely to get what you want with that approach. Again, a physical exam is very important to make a definitive recommendation. I hope that was helpful, I wish you the best of luck and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.
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