What Can I Do About my Under Eye Bags and Lines? (photo)

Doctor Answers 5

Scar-less surgery to treat the eye bags, and non-surgical treatments for the fine lines

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As an oculofacial cosmetic surgeon, this is probably the most common question I get every day in my practice. Since puffy eyes and lines under the eyes are among the first things to happen to many people as the first signs of aging, or have hereditary puffiness under the eyes.

Before they come and see us, a lot of our patients try to treat the puffy bags by using over-the-counter creams and lotions that are guaranteed to help. These don't work because the problem, called lower eyelid fat prolapse, happens inside the eyelid so there’s no topical cream that can help that area.

The puffy bags under the eyes are actually fat pockets inside the eyelid that push forward, which is generally a genetic trait. If eye bags run in the family, or there are members of the family who have them, there’s a very good chance that you have them as well. In my 20 years of practice, I’ve actually operated on three generations of the same family many times, so the genetic component is a real factor.

Earlier in my practice, I used to treat the puffy bags as an isolated procedure, but as soon as the bags were gone and the eyelids were healed, patients were concerned about the lines and wrinkles. Now my approach is to first identify the different components under the eyes. So I do lower eyelid surgery or transconjunctival blepharoplasty, where I take out the fat pockets from the inside of the eyelid, and combine that with a procedure that helps the fine lines and wrinkles to comprehensively enhance and rejuvenate the eye area.

We specifically use a fractional CO2 laser that helps stimulate new collagen and restore almost a baby-like smoothness to the skin.  We also do something interesting called platelet-rich plasma, which is derived from your own blood like a typical blood draw from a blood test.  We concentrate the platelets which the component of the blood important for clotting and healing. This helps with collagen remodeling, building and improving areas such as fine lines and wrinkles. We also use it for acne scars. and in combination with ACell in our hairloss division in our practice. This combination of addressing the puffiness and treating the lines at the same time is an excellent way for our patients to look brighter.

To summarize the recommendations for your concerns, transconjunctival blepharoplasty which means removing the fat bags from under the eyes and combining that with fractional CO2 laser and platelet-rich plasma will be typical approach in my practice. The only thing that I can’t do is a physical exam to understand the quality of your skin and the other anatomic aspects of your eyelid.  I hope that was helpful, and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Improving lower eyelid hollowness and bulging fat

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Options to recontour the lower eyelid include Belotero or Hyaluronic acid facial fillers; or lower eyelid blepharoplasty. These provide safe solutions for your cosmetic eyelid problem. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Lower eyelid surgery-I don't think so.

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The thing in your lower eyelid that looks like orbital fat is your orbital rim.  A surgeon operating on your eyelid would be in for a bit of a surprise.  You can evaluate yourself.  At a mirror, take your finger and place it on the lower eyelid bulge.  You will notice that it is hard.  That is because it is not caused by herniate orbital rim fat.  Due to the descent of your cheek fat, the bone of the orbital rim is exposed and the projection of the bone makes this fullness.  Your best option is not surgery but hyaluronic acid fillers.  Not any hyaluronic acid filler: Restylane is the best choice for this situation.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Transconjununctival fat repositioning

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Transconjunctival blepharoplasty with fat repositioning would be a great option for you. If you do not want to undergo surgery, fillers with be a good option for you as well, thought not a permanent solution.

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

Options to treat under eye bags/lines

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There are basically two options to treat under eye bags.  You could have surgery to remove some of the protruding fat that causes the bag or you could have a filler, like Restylane, placed under the bag to fill in the area of depression.  Lines under the eyes can sometimes be improved with a filler injection, surgery, or procedure such as laser resurfacing or chemical peel.  

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.