What is the cause of the fat pad under my eye, and how can it be treated? (Photo)

I’m a cosmetic oculofacial plastic surgeon, board-certified by the
American Board of Cosmetic Surgery. I’ve been practicing in Manhattan and Long
Island for the past 20 years and under eye bags is one of the most common
issues we treat in our practice.



Your eye bags are caused by lower eyelid fat prolapse. This means that
the fat that is normally around your eyes pushed forward and creates a hernia.
Once the fat pockets have pushed out, it pushes out even further as time goes
on. There are numerous factors that can contribute to it getting worse but the
fact that you have a significant asymmetry clearly draws a lot of attention and
people asking you if you are tired.



When you look for solutions for under eye bags, it’s likely that you’ve
already tried the topical creams and moisturizers that are typically sold and
of course, those don’t work. When you’re dealing with a physical volume of fat,
nothing topical will make a difference. There are also options using various
types of hyaluronic acid fillers to camouflage the fat. This is unfortunately not
likely a benefit for you. In the absence of a physical exam, it seems pretty
obvious from your photo that the bag is too prolapsed out to hide it or
camouflage with a hyaluronic acid filler.



In our practice, for someone who’s young, we typically address this
problem through a procedure called a lower eyelid transconjunctival
blepharoplasty. The reason why I use the term transconjunctival has to do with
the approach. There are two ways to address fat pockets: from the outside
called transcutaneous approach, and from the inside called the
transconjunctival approach. For younger people, usually there is no issue with
extra skin and therefore there is no reason from my perspective to go and make
an incision on the outside. What we do is we address the fat pockets from the inside
of the eyelids so there is no external scar.



We also perform these procedures in our office facilities under local
anesthesia with LITE™ sedation so you avoid general anesthesia. A lot of
surgeons prefer general anesthesia. I have been doing this procedure for over
20 years and I have a lot of experience with it. I find that the experience of
the patient is better when they avoid general anesthesia, and are able to
recover a lot faster without the side effects of the medications. By avoiding
all the stress of general anesthesia by using local anesthesia with sedation, most
of our patients go back to work in less than a week.



I recommend that you meet with qualified, experienced cosmetic surgeons
and learn about the options. Get to know your doctor and get a sense of what
that doctor’s aesthetic and style are. Get a sense of what you can anticipate
your final appearance will be. What I explain to my patients is that when you
have this procedure done, because you had puffiness for so long, it’s hard to
imagine yourself without the puffiness and there’s a common concern of being
over hollow. Our goal is to achieve a look as if you never had the bags. This
means that the skin will naturally follow the contours as if there was no fat
prolapse there. I hope that was helpful, I wish you the best of luck, and thank
you for your question.



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Thank you for sharing your question and posting your photograph. You have  fat protruding forward in the lower eyelid. This can happen due to genetics or aging. The treatment is Blepharoplasty which is the removal of excess fat and tightening of the skin. This is commonly performed be Oculoplastic Surgeons. Recovery takes about 10-14 days. See an experienced Oculoplastic Surgeon for comprehensive evaluation and discussion of treatment options. Good luck,

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately.  All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.