Are my eye bags from fat or fluid? They're worse in the morning but never completely go away. (photo)

Question

I'm 41 years old and I've had them for years. They're worse in the morning but never completely go away. I have a lot of allergies and sinus problems. When I press on the bags I feel bone. I also have high, prominent cheekbones and very low fat on my cheeks.

Jonathan Kulbersh, MD · Answer

This is most likely a combination of fat and some fluid. Under eye bags can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella).There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Jason Emer, MD · Answer

Thank you for your question. There are many things you can do to treat under eye bags, but a combination approach with nonsurgical treatments would give the most improvement: fillers (Belotero, Juvederm Volbella), lasers (Fraxel/CO2), Renuvion (J-Plasma), microneedling/PRP, Cosmelan peels and stem cells. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest getting a formal evaluation with a cosmetic dermatologist to see what is best for you and your goals. Best, Dr. Emer.

Mehryar (Ray) Taban, MD, FACS · Answer

You definitely have under eye fat bags which are likely worsened in mornings by extra fluid collection. Consider transconjunctival lower blepharoplasty with repositioning of the fat bags to the hollow area.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photograph. Your lower eyelid bags are probably a combination of both fat and fluid. Typically, the fat swells over night when  your head is low and allergies also increase swelling around the fat. Sleeping with your head elevated and cold compresses might help with the swelling, but you probably require Blepharoplasty to remove the fat. See an experienced Oculoplastic Surgeon for comprehensive evaluation and discussion of treatment options. Good luck,

Laxmeesh Mike Nayak, MD · Answer

In your specific case, the puffy areas are fat pockets. 
In my experience, the best results are achieved by transconjunctivally removing the excess fat from the puffy area, as well as restoring the lost volume in the hollow areas with fat transfer and laser resurfacing.
These procedures together have a 7-10 day recovery, have no visible incisions, and generate beautiful, natural, long-lasting results.

Kami K. Parsa, MD · Answer

If there are variations on your symptoms, meaning one day it is more swollen than other days then its mostly fluid retention. Try these things: 1. Cut down on salts preservatives 2. Sleep on your back 3. Avoid sleeping on your face. You need to be evaluated by an oculoplastic surgeon to find the best treatment option for you. Unfortunately a picture is not sufficient to determine the cause and treatment. For more information visit our website.

Luis A. Cenedese, MD, FACS · Answer

Lower lid lines are best treated by lower blepharoplasty.  When properly performed wrinkles are always improved.  Scars are difficult to detect; deformities are rare.  Results last for years.  
Non surgical options include CO2 LASER and Phenol Peel. One treatment typically produces results lasting for years. Fraxel LASER, Radio-Frequency treatments and micro-needling with PRP or stem cells are good options.  Several treatments are required lasting up to one year.
Puffy eyelids(bags) are most often caused by bulging of the fat which supports the eyelids. Certain anatomies of the lower eyelid region predispose young people to this deformity. Loss of volume of the bony infra-orbital rim accentuates this problem in older individuals.
Various options are available. The most successful is injection of filler below the lids and the tear trough.  Hyaluronic acids are most commonly used as they correct the majority of the defect.and last well in this area. The addition of PRP or Stem Cells can help to lighten the skin of the area as well as prolong the duration of correction. Hyaluronic acids can cause a bluish discoloration when injected under the lids. Techniques exist to decrease the probability of this occurring. Over correction with bumps is not rare. These are easily corrected with an injection of Hyaluronidase. Fat injections with their stem cells are more long lasting solutions which in addition correcting the defect help to improve the color and quality of the overlying skin.
Eyelid bags may be successfully diminished by injection of a few solutions. One to a few sessions result in long lasting correction.
Please consult in person with an experienced Board Certified Plastic Surgeon prior to making treatment decisions.

Camille Cash, MD · Answer

Based on your description and photo it is most likely that your bags are a combination of fat and fluid.  Seeing an allergist is always a good idea for your to help control your allergies, but there is also a solution for your eye bags.  During a lower blepharolplasty surgery excess fat and skin is removed.  Remaining fat is redraped, revealing a smoother under eye appearance.  See a board certified plastic surgeon in your area to learn more.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You are 41-years-old, and asking if your eye bags are caused by fat or fluid. You add that you have sinus and allergy issues, and your bags are worse in the morning, but never completely go away. You also say the bags feel like bone.
I can certainly help guide without a submitted photo for reference, and without the benefit of a physical exam. As an oculoplastic surgeon practicing in Manhattan and Long Island for over 20 years, I perform procedures for the upper and lower eyelids every day in my practice.
I think it is likely that your eye bags are a combination of your sinus and allergy issues, as well as fat. Eye bags that are present all the time are caused by the fat that normally cushion the eyeball push forward, creating these bulges. Since the fat doesn’t move back below the eyeball, the puffiness and prominence are present all the time. Intermittent issues with allergies and sinuses can make the eye bags look worse at times, but do resolve when they are not triggered. 
In a situation like yours, I would have the allergies and sinus issues managed first, and see how your under eye area looks without the inflammation. I would then consider performing a transconjunctival blepharoplasty, where fat is sculpted and removed from behind the eyelid, and no outside incision is made to preserve the support structures of your lower eyelids, and look completely natural. If surgery is warranted, it is important that it is done when you have no sinus or allergy attacks, as a little fat is left behind for a contour of the lower eyelids, and to prevent you under eye area from looking hollow. 
I suggest you consult with an eyelid specialist for a proper physical examination of your eyes, and determine how much fat is causing your puffiness. Lower eyelid surgery can be done under local anesthesia, and while it is surgery, it is very routine for an eyelid specialist, and you can be back to work in about a week. Ask for the transconjunctival blepharoplasty by name as it is more specialized than the transcutaneous blepharoplasty procedure. The transcutaneous method is more common, and involves an incision in the lower eyelid, so it is more prone to complications, can change the natural shape of your eyes, and may make managing your allergies more challenging during recovery. I hope you found this information helpful. Thank you for your question.

Diana L. Elias, MD (retired) · Answer

It is a little difficult to tell from your photo but it looks like the bulging is above the orbital bone rim. This would correspond with herniated fat under the eyes and could be improved with surgical removal. However, you mention that it is worse in the morning which suggests an inflammatory process such as allergies which can only be improved with medical treatment. It is essential that both issues be discussed with your doctor to determine the best approach to your situation.

Are my eye bags from fat or fluid? They're worse in the morning but never completely go away. (photo)

Answers (10)

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