For my under eye bags, should I go with blepharoplasty or fillers? (photo)

I am 27yrs old and my under eye bags are hereditary. I have tried many products but my bags are always there and have gotten worse over the years, I feel like the skin under my eyes is very droopy. I would like a permanent solution.

Doctor Answers 9

The permanent solution for the fat that causes eye bags is surgery, but it can be done without a visible trace of surgery

It appears that the puffiness under your eyes is a a condition called lower eyelid fat prolapse, also referred to as extraconal fat - the fat normally around your eyes has pushed forward. Generally, when that fat pushes forward, it creates this continuous appearance of puffiness. Puffiness under the eyes is perceived by most people as looking tired. Very often, patients who come to us say that they are tired of being asked why they are tired.

In our practice, for most of our patients who are younger who have good skin quality and skin tone, we perform a procedure called transconjunctival blepharoplasty. Transconjunctival blepharoplasty is a technique and a procedure where we address the fat pockets from the inside of the eyelid, involving reduction, repositioning and whatever else needs to be done. This way we avoid any external scars and there is a real preservation of the overall anatomy of the lower eyelid so that it looks very natural. In fact, once it’s done and you’re healed, it would be difficult for anyone to tell that you had this procedure.

In addition, we perform this procedure under local anesthesia with LITE™ IV sedation which means we avoid general anesthesia. Every procedure in our practice, with exception of rhinoplasties (nose jobs) are done under local anesthesia, including: facelifts, liposuction and tummy tucks.

Transconjunctival blepharoplasty is a very nice, natural and quick recovery method to address the fat pockets permanently and they will not come back. Properly taking care of your health and doing the right things that are good for the skin will certainly enhance the benefit of the procedure.

At this point, it’s best if you meet with qualified and experienced cosmetic surgeons. Meet with somebody who you are comfortable with and you’re comfortable with the way the procedure is done. Look at the results such as the before and after pictures. These are things you need to understand so that you can make a decision about not only the surgery but also how that surgery is done so you can get the best experience you can. I hope that was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Lower eyelid bags

Lower blepharoplasty is definitely a better solution.  However, if you are not ready for surgery because of down time, or financial reasons then fillers are a good alternative. 

Dr J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 107 reviews

Lower eyelid bags

Looking at the frontal view of your picture it appears that you already have a dark semi- circle of your lower eyelid. In these cases it is usually better to fill the depression(with Restlane ,or Belotero) in order to camouflage the dark "tear trough" than to remove fat above this depression because  removing fat in this setting may actually make your eyelid appear worse. The correct plan can only be determined with a direct examination of your eyelids. 

Joel E. Kopelman, MD, FACS
Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

For under eyes, lower bleph or fillers?

Hello and thank you for your question.
Your photo is a bit limited. However, the only permanent solution to removing eye bags is a blepharoplasty. I perform this procedure routinely in my office with an incision inside the eyelid that can never be seen! Alternatively, you can potentially camouflage the under eye bags with filler or fat transfer, but the former will need to be repeated every 6 months or so.I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.
Best of luck to you!

David L. Cangello, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 14 reviews

Blepharoplasty or fillers?

Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient with bulging herniated fat pads and accompanying areas of hollows of their lower eyelids: temporary fillers with hyaluronic acid fillers like Restylane which usually last 6 months to 1 year, micro-fat grafts of your own tissue - 30-50% lasts permanently, and blepharoplasties . There is no one best procedure that would be applicable for everyone. Each has benefits and potential drawbacks. The vast majority of board certified plastic surgeons with extensive experience in eyelid surgery and soft tissue fillers would warn against using a permanent synthetic filler because of the long term complications which can occur even years after injection and are difficult if not almost impossible to correct.

The best option in any particular patient needs to be individualized based on desired outcome and personal anatomy. If the fat pad fullness is significant, just adding a filler or fat grafts generally does not produce a satisfactory cosmetic improvement.

Following the advice of anyone who would presume to tell you exactly what to do without seeing 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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

You have a dark tear trough.

You have a small amount of prolapsed orbital fat which creates a shadow and makes it look darker.  At age 27 I would recommend some filler to help fill in the tear trough.  Since there is not much movement in this area, the filler will usually last at least a year. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

The key is in your last sentence...

If you want is the way to go. Fillers, especially fillers for the lower lid, tend to be "thinner" and thus shorter lived. If permanence wasn't your main goal, I'd try fillers first. They are cheaper and less invasive. Good luck.

Robert Frank, MD
Munster Plastic Surgeon
5.0 out of 5 stars 34 reviews

Both are options

The best way to answer your question is to consult with a cosmetic facial surgeon or eyelid specialist in the office. It appears from your photo that you do have hereditary bags, and this can sometimes be made less obvious with fillers around the bags in the depressions. Fat transfer is a longer lasting procedure with the same concept.
Surgery can remove the fatty bags as well. At your age, you should seek an expert opinion before undergoing any procedures for the best possible result and the lowest risk.

Malena Amato, MD
Austin Oculoplastic Surgeon
5.0 out of 5 stars 2 reviews

Treatment options for under eye bags

Under eye bags are sometimes hereditary in nature, as in your case.  Generally speaking, they can usually be improved with either fillers or surgery.  Fillers can be placed under the bags to help camouflage them or surgery can be done to address the fat causing the bags.  The surgical option is longer lasting.  

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.