Filler or Surgery for Under Eye Bags? (photo)

I'm a 29 year old female with what I think are bags and dark circles under my eyes, but having done some research I think the appearance of bags might be hollowness. Considering filler or lower lid surgery and seeking advice on which would be best for my case?

Doctor Answers 16

It is likely that you can have filler alone and be quite happy with this approach.

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You do have a small pillow of herniated fat.  This is what is removed with surgery.  However, yours is small and once it is removed, you will still have a hollow.  For quite some time it should be possible to simply fill this area.  The challenge is that this is an advanced service.  You need to find a highly experienced injector to get the most from this type of treatment.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Two options

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You have two options here that will work well for long as you have an experienced surgeon that is comfortable with this type of surgery or filler

1. Transconjunctival blepharoplasty with fat transposition and not removal. This will mobilize the pooched out fat and reposition it into the hollow below, minimizing eyelid hollowness

2. Hyaluronic acid filler to the tear trough below to camouflage the prolapsed fat.

Both options are excellent when done right. The benefit of the surgery is that it is a more permanent solution. The fillers will need to be repeated.

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

Why fillers are popular, and why surgery is more reliable and longer lasting

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When fillers became more and more popular, there was  a lot of misinformation about what fillers can do about under eye bags. Physicians who cannot perform surgery advocate for these to avoid "the knife".  However, after practicing for 20 years and specializing in oculoplastic facial reconstructive surgery, I can say that this is not practical.

Fat pockets in the lower eyelid that have pushed forward is a condition called lower eyelid fat prolapse. It’s like a hernia where the fat is in a place where it’s not supposed to be. Fillers will only add volume to where that hernia is and will just make the eyelids look puffier. In my practice, I help my patients who had fillers placed by dissolving it with a material called hyaluronidase.

I recommend a procedure called transconjunctival blepharoplasty for lower eyelid fat prolapse instead of fillers. In this procedure, I sculpt the fat from behind the eyelid so that the contour and shape of the eyelid looks natural. Patients who had this procedure look as if they never had under eye bags or had any surgery performed. After reducing the fat pockets, I would consider adding volume to the cheek  because if someone has a relative shallow cheek where its projection is back, they naturally will look a little bit hollow. Adding volume will give a good contour and youthful appearance to the under eye area.  I hope that was helpful, and thank you for question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Filler or surgery for lower eyelid bags.

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The ideal result will be achieved by both filler and lower eyelid surgery.  Your lower eyelids demonstrate fat herniation above the level of the orbital rim and a relative soft tissue depression paralleling the rim of the eye sockiet (tear trough or nasojugal groove).  If you choose surgical improvment the herniating orbital fat can be transposed over the lower eyesocket rim and therefore take care of both problems with a single procedure.  Alternatively the orbital fat can be discarded and micro fat transfer to the nasojugal groove can be performed.

Mario J. Imola, MD, DDS, FRCSC, FACS.

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 124 reviews

Filler or Surgery for Under Eye Bags?

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    A lower eyelid surgery to correct the fat herniation or for conservative fat resection or transposition would be helpful.  In addition to the lower eyelid surgery, filler such as Restylane or fat grafting to the tear trough can produce a nicer smoother result.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Lower lid options...

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both would work but as surgeons, our preference is to go for the long term fix and have the surgery as the costs of filler will eventually accumulate and exceed the cost of surgery.  The procedure can be done under local to cut costs but it is much more comfortable having it under anesthesia.  Finally there are doctors that remove the fat and those that move the fat around... choose what will work best for you.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews


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You have herniated fat pads of the lower lids.  Recent studies show that this is due to a proliferation of fat and not a weakness of the orbital septum or muscles as we all thought in the past.  You have mild protrusion of your eyes in relation to your cheeks. If too much fat is removed, you will accentuate  this condition.  A conservative transconjunctival blepharoplasty is an appropriate option for you. Deep filler below the infraorbital rim may also be indicated, but only after the blepharoplasty has healed and an accurate evaluation can be made.  Best wishes. Knowledge is power.  Luis F. Villar MD FACS

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

Lower lids

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Based on your photos, you have prominent fat pads due to a weak orbital septum( mid lamella). The fat removal from inside the eyelid is a good solution to consider. Get a consult from a board certified plastic surgeon in your area.All the best.

You Could Have a Lower Blepharoplasty or Non-Surgical Eyelid Lift

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You have prominent bags underneath your eyes.  They are seconday to fat herniating out of the eye socket.  Surgery to remove or redistribute the fat would fix the problem while fillers in the area will help hide the issue.  Surgery is more risky but permanent.  

Fillers versus blepharoplasty for lower eyelid bags

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 The photographs show significant herniation of fat in 2 out of 3 compartments of the lower lids.  Fillers will mask  this issue, not treat the bags. The best solution is a trans-conjunctival approach  lower blepharoplasty with the conservative removal of fat, and no external incisions. The fat is removed  during the outpatient surgery and expect about 10 days of down time with some degree of swelling and bruising after the procedure. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 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.