I'm 25 years old and have double bags under my eyes. What treatment would you recommend? (photos)

Dear DoublebagsThank you for your question!  From your photo- the swelling and line seem to be from "malar edema" - the line along which the lymphatic outflow around your eyes- is a little backed up, causing the swelling.  This is not always easy to treat.  Fillers may soften this a little- but sometimes can make it worse.With Warm RegardsTrevor M Born MD

I would start with Belotero or Restylane for your tear trough. They don't absorb as much fluid as some of the other fillers and work great in that area. It's not uncommon to see this issue in younger patients. The problem is that you would have to repeat injections every 8-12 month. Once you have gain trust in your injectors abilities you could do something more permanent like fat transfer. 

Hi DB.  Not to worry, you are an EXCELLENT candidate for tear trough injections with Restylane.  In fact, our youngest patient for this procedure was very much like you.  She was only 18, but because of her genetics, the under eye area was very withdrawn (sunken) and darkened.  She had excellent results with Restylane and you will also - provided you find the right injector.  To find before and after pictures of Restylane under the eyes for our Orange County, CA patients, check the link below.

In
my view, the most important thing you can do is to find a board
certified plastic surgeon who is has significant expertise treating the
eye area and lots of tools to use. Finding a strategy that works for
you may involve trying more than one approach, so having a trusted
partner is important.
The
first step is an in-person exam. This will give your doctor more
information about what's happening beneath the skin. He or she may
recommend a filler to plump up the depression from underneath or fat
grafting. Another option may be repositioning the naturally-occurring
fat pads under your eyes. There may be other options as well.
In
addition to possibly trying more than one treatment, it could also be
that you go with one solution now and a different one later on. That's
another good reason for forming a partnership with a talented cosmetic
surgeon.

Just adding filler alone when there is significant puffiness or bagginess may just add to the volume and puffiness overall.  First, I would suggest testing to see if the bags shrink with a low dose of a diuretic pill prescribed by your physician, and if the puffiness does not fully resolve with this test, then you may also have a hereditary fat pad.  Such fat pads can be easily removed with a small laser incision on the inside of the lower eyelid.  I prefer this technique referred to as laser lower blepharoplasty.  There is less bruising, bleeding and swelling than when it is done with a scalpel.  In addition, a small amount of Botox is helpful for the small wrinkle and roll directly under the lash line.  Filler is helpful for any residual tear trough groove.

It appears that you have flat cheekbones which are causing the premature aging changes seen around your eyes.In young patients like yourself, I find that treating these areas with a filler such as Restylane, or building up the cheeks with a similar filler (Juvederm Voluma), essentially eliminates the problem with minimal downtime and no surgery.  If this works well and you would like something more permanent, a treatment such as fat grafting can be done as an outpatient surgery.

Most expert
experienced artistic plastic surgeons have a variety of procedures, both
non-surgical and surgical, at their disposal to produce excellent cosmetic
results in the appropriately selected patient: temporary fillers, micro-fat
grafts, and blepharoplasties. There is no one best procedure. Each has benefits
and drawbacks and depends on desired outcome and individual anatomy.Patients your age and with anatomy often do very well with a hyaluronic acid filler like Restylane.


Following the advice of anyone who would presume to tell you exactly what to do based on seeing limited 2 dimensional photos and without taking a full medical history, examining you,
feeling and assessing your tissue tone, discussing your desired outcome and
fully informing you about the pros and cons of each option would not be in your
best interest. Find a plastic surgeon that you are comfortable with and one
that you trust and listen to his or her advice. The surgeon should be certified
by the American Board of Plastic Surgery and ideally a member of the American
Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns
with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

The puffiness with a crease below on the cheek is called a festoon or malar bag.Surgical treatments are fairly extensive and do not always work.In my experienced dermal filler injections can make a nice result and avoid surgery.For more formation on eyelid surgery please read the following link: