I Am Trying to Find What Eye Surgery is the Best Option for Me to Remove the Puffiness Under my Eyes? (photo)

I'm developing mild bags under my eyes. I'm trying to decide if the laser or the fat filler is the best option. Can anyone help? I'm diabetic so I'm also concerned with minimal invasiveness

Doctor Answers 6

Blood supply in eye area is very good so eyelid surgery is safe for diabetics, but fat transfers to the eye area is risky

With diabetes, we’re concerned about circulation and healing and that tends to be a problem for people especially in their extremities like the feet or the hands, but the face has a very good blood supply. Based on my experience, I haven’t found an issue in terms with the healing in the space around the eyes. That still means that we have to do very good surgery with minimal trauma, and monitor for proper healing. 

If you have a small amount of puffiness and it appears you are relatively young, then I would say a transconjunctival blepharoplasty which is the reduction of the is probably your ideal choice because: fat pockets are reduced from the inside of the eyelids so there's no outside incision, it’s minimally traumatic, and it doesn’t compromise the blood supply to the eye. Since I can’t asses your skin quality or if there’s any extra skin, I can’t recommend a skin removal or laser treatment.

As a board certified cosmetic oculofacial plastic surgeon in practice for 20 years, I would not recommend placement of fat directly on the under eye area. I use fat routinely in my practice and use it in the cheek area and to the other parts of the face where there are nasolabial folds. It’s not that I’m against the use of fat but I have found placing fat in the under eye area is a very risky. The reason behind that is because the skin on the under eye area is very thin so there’s a tendency for different kinds of scarring and an unpredictability of healing to occur. There’s a very well-known plastic surgeon in New York who did a lot of fat transfers in the under eye area. Unfortunately, a lot of his patients ended up with chronic swelling and problems. Very often, the doctors will start using it and like it for a while, but as the swelling resolves, there are lumpiness and irregularities. So I don’t recommend placement of fat on the under eye area directly.   I hope that was helpful, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 69 reviews

How to improve lower lid contour

Thank you for submitting your photos. They are a little small but I can see that you have mild lower eyelid bags. In general lower eyelid bags are caused by pockets of fat that begin to protrude beyond the muscle that was once holding them back. Pockets of fat can be surgically treated with a transconjunctival blepharoplasty.

Hyaluronic acid filler can sometimes be used to disguise lower eyelid bags although I'm not sure this would give you the result you are hoping for. Filler adds volume to the under eyelid area so that the bags look comparatively less puffy than they did before.

Injection type fat transfers below the eye can be problematic in this delicate area so proceed with caution if you decide to go this route.

The history of diabetes is not a significant risk factor for a lower blepharoplasty. The video below explains the transconjunctival approach to lower eyelid blepharoplasty - which is ideal for young patients who are bothered by herniated pockets of bulging fat in the lower lids but don't have pronounced skin laxity. The surgery isn't minimally invasive, but it has a shorter recovery period that a traditional lower eyelid surgery done with a subcilliary approach. Most patients are back to work after a week and have little to no bruising or swelling at that point. The incision is hidden inside the lower eyelid so there is no visible scar.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 105 reviews

Transconjunctival Lower Blepharoplasty In A Diabetic

Based on this one grainy picture, it does not appear that either a laser or fat injections is the appropriate treatment. Removal of the protruding lower eyelid fat from incision inside the eyelid would be the best treatment. This is not at increased risk of infection or healing problems in a diabetic.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Surgery or filler for under eye bags

Generally, there are a few options to improve the appearance of the lower eyelids, eye bags, or dark circles. First option includes basic skin care, tretinoin, and/or chemical peels. This nonsurgical method helps improve the skin quality, reduce pigmentary changes, and improves overall appearance of the lower eyelid & cheek areas.



Second more advanced option is an injectable filler or fat to plump up the area. Fillers are made of material that is slowly removed over time. Facial fillers treatment is performed in the office vial local anesthesia. Examples may include Restylane or Belotero.


The last option, and also the most aggressive, is eyelid plastic surgery. Cosmetic surgery of the lower eyelid may remove or reposition fat in the eye bag area, and possible remove some sagging skin. Plastic surgeons typically don't recommend cosmetic eyelid surgery in young patients. However, each patient is unique and circumstances may vary. Age alone is not a determining factor if a person is a cosmetic surgery candidate.


Only after a comprehensive evaluation can a specialist help determine appropriate options for you. It's difficult to provide a more specific recommendation based on a single photograph alone. Some patients may try a non-surgical filler first, then later proceed with eyelid surgery. Best of luck.


Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Puffiness under eyes

From the photo, it is hard to tell exact the anatomical problem you are having and wish to correct. The fullness of your lower eyelids is usually fat bulging out like a pillow behind a theatrical curtain. That requires surgery to remove the fat pads. Treating the skin itself depend whether it is wrinkled or excessive. Wrinkled skin can be treated with an ablative laser where excessive skin needs to be removed.

Occasionally hollowing especially medially can be treated with injectable fillers

David Ellis MD FRCSC

Toronto Facial Plastic Surgeon

Art of Facial Surgery


David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
3.5 out of 5 stars 8 reviews

Options for treating bags under eyes

Your picture is not ideal seeing what your problem is.  A close up of your eyes would be more helpful.  If you do have mild bags under your eyes, a laser would not be the typical treatment used to help with this issue.  Your options would be to have surgery to remove some of the fat that is causing the bag or to use a filler to inject under the bag to camouflage it.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.