Do I Need Fat Removal or Excess Skin Removal Underneath my Eyes with Blepharoplasty? (photo)

Hello, I'm 24 years old and I have dark circles/bags under my eyes. These will not go away with make up as I have shadowing under my eyes under certain lighting that make them look worse. I was looking at lower eyelid blepharoplasty as an option. I've come to realise that there are different ways of doing eyelid surgery. I'm just wondering, whether anyone can help me answer, do I need fat removed from underneath my eyes OR excess skin removed by an incision near the lash line?

Doctor Answers 7

That "bag" is probably your orbital rim.

Put your finder on the "bag."  If it is hard, your are feeling the orbital rim.  Surgery will not fix that.  Of course that does not mean that surgeons won't give it a try if you let them.  Very simply, the best option for you may be under eye filler with Restylane.  For many of my patients your age and with your issue, service seems to last 12 to 24 months before being topped off.  Think about it, no surgery, great result, easy to have as an office procedure.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower Fat pads in lower lids at 24 years old? Yes, possible!

Hi, thanks for your question. I have a busy practice downtown Toronto and #eyelidsurgery is an important part of my practice. Most people develop herniation of lower lid fat pads over time - usually starting in their 40s. Yet, a few are genetically predisposed to premature herniation. Your mom or dad may have had premature fat herniation as well.

You may try first some fillers, such as juvederm of restylane, which would 'camouflage' the above fat pads; it works well but it is temporary.

Otherwise, a conjunctival (internal lid) approach would be sufficient to remove the excess of fat without an external scar.

Hope this helps!

Best, Dr. Marc DuPere, eyelid and plastic surgeon, Voted Top Plastic Surgery Clinic Toronto 2013

Marc DuPéré, MD
Toronto Plastic Surgeon
4.8 out of 5 stars 62 reviews

Eyelid skin removal is always cautioned, and you don't have an excess. Your eye bags can be treated with no outside scar

The puffiness in the lower eyelid is called lower eyelid fat prolapse. This means that the fat that’s normally around your eyes pushes forward and creates a bulge. This is typically a genetic issue, but other factors such as environment, sinuses, allergies and eye rubbing can also accelerate this puffiness.

To address lower eyelid fat prolapse, I would often do the procedure from the inside of the eyelid called transconjunctival blepharoplasty. This way, there is no outside incision and needed to cover the eyes is not removed. This is also prevents the pulling-down of the lower eyelid called eyelid retraction.

In my practice, I also use regenerative medicine using a material called extracellular matrix (ECM) derived from pig’s bladder. This material has been used to regenerate hair and was primarily developed for wound healing. I use this material with a vehicle called platelet-rich plasma (PRP). Platelets are cells in the body that are responsible for healing and can improve skin quality. In other fields such as oral and orthopaedic surgery, they also use platelet-rich plasma to accelerate healing.

Dark circles are mostly based on one’s ethnicity as well as environmental factors such smoking, sun exposure as well as the skin's thickness. When the skin is thin, you can literally see through the skin and look at the muscle and the blood supply underneath. To address this, we often use platelet-rich plasma to improve the skin quality and texture.  I hope that was helpful, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Shadowing under the eyes

This is an extremely common complaint.  You like most with the problem have a mountain--the bulging fat and a valley--the depression beneath the mountain.  The simplest improvement is filler injected in the valley also called the tear trough.  Filler actually can last a year or two there.  A better filler is your own fat and that if it takes may last the rest of your life.  The best result is addressing both the mountain with fat removal and addressing the valley with fat injection.  It is very reasonable though to first get a big improvement filling the valley in one of the two above ways.  Many patients are satisfied with this and don't go on to a blepharoplasty to remove the fat.  By the way, whoever treats this problem should take shadow pictures to document it.  If only flash photos are taken you will not see the real improvement in the after pictures.

Thomas Hubbard, MD, FACS
Virginia Beach Plastic Surgeon
4.8 out of 5 stars 37 reviews

Fat removal for lower blepharoplasty

 Without examination, it is impossible to tell but there appears to be either a bony orbital rim protuberance, or herniated fat. At age 24 there is no excess skin, so no skin removal is needed. If the area in question is indeed herniated orbital fat, then a trans-conjunctival  approach  would be required to remove a conservative amount of fat.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Surgery not the best answer

Dear Tee

You have two concerns "dark circles" and "bags under the eyes".  

Let's discuss the bags first. From what can be seen from your photo you have modest protrusion of the lower lid and a deep depression between the lid and cheek. You have young tight skin. You should not have any procedure that removes skin or even goes through the eyelid skin. Cutting through skin (and muscle) has real potential for complications for no gain in your situation. One option is a procedure that makes a small  incision on the back side of the lid and remove the fat that will pop out. This will reduce the bag but can sometimes produce a slightly hollow look. The second option is less invasive and is to fill the depression between the lid and cheek. The best agents for this are hyaluronic acid filler, Restylane is usually the best of these for this, or your own fat. Restylane will last about a year and, performed correctly, the fat will last decades. Whether you lower the prominence or raise the depression the the effect will be to reduce the shadow cast by the bag and help the area to appear a little less dark. Facial Plastic Surgeons, Oculoplastic Surgeons and Plastic Surgeons perform all these procedures. Dermatologist also perform the injections. Regardless of background chose a practitioner with experience and a proven record in the technique you decide on.

Concerning the "dark circles": As already explained, reducing the shadow will help the darkness. The photo shows that you have dark skin around the upper and lower eyelid areas. Usually the is hereditary and little can be done directly for this. Sometimes treating chronic allergies will help. 



Curtis Perry, MD
Downey Facial Plastic Surgeon
4.8 out of 5 stars 19 reviews

Skin or Fat

At 24 yo it seems unlikely that you have excess skin. However, you may also want to consider lower blepharoplasty with fat repositioning. This will move the fat into the hollow area giving you a smooth transition from the eye to the cheek. Effectively obliterating the dark shadowed area. You should have a complete evaluation by a Board Certified Surgeon in your area.

Deidra Blanks, MD
Wilmington Facial Plastic Surgeon
5.0 out of 5 stars 3 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.