Genetic Undereye Bags - Only 22 Y.o.? (photo)

In many cases, puffy lower lids in younger patients (less than 40) are genetic.  They usually have good facial development other than having the puffy lower lids.  Sometimes the puffiness fluctuates, in which case, the puffiness is more from fluid than from fat under the eyelid.In your case, based on the photo, I believe you have some volume loss around the cheeks and eyes and adding volume instead of surgery would be the better option.  Consider visiting a board certified facial plastic surgeon near you to determine your best options. 

There are many causes of eye bags. Some are shadow issues, some are discoloration issues. Most people have a multifactorial issue meaning they have more than one problem causing this demarcation. So it is good that you notice for instance that allergies make them worse. We need to get that treated for sure. Below are some common causes and my treatment process for this issue. There are also a few videos explaining my thoughts on the issue. 

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

I know how frustrating it is to have puffy bags under the eyes and it’s certainly understandable why you’re seeking advice. I can tell you that I’ve had patients who are considerably younger. Our youngest patient was actually 14 years old, who was teased at school because he had very big bags underneath the eyes.

A lot of our patients come to us after they have tried all kinds of things such as topicals or creams that are guaranteed to get rid of puffy bags but never actually work.  Fat pockets are normally underneath your eyes, but due genetic reasons they push forward and create these pouches under the eyes.

The condition you have is called lower eyelid prolapse. Looking at the photos you sent, it looks like a mild to moderate case. Before proceeding with a surgical procedure, you could consider the placement of a hyaluronic acid filler, such as Restylane, along the tear trough area. Of course maintaining fillers can be expensive but as a temporizing solution, it might be worth considering.

A lot of people end up having a dermatologist or non-surgical specialist to fill up the area with hyaluronic acids, but this can create a lot of puffiness. Very often we need to use something called hyaluronidase to actually dissolve it. If the bulge of fat is more than the hyaluronic filler, then you might have to consider another solution.

For my younger patients, I recommend a procedure called transconjunctival blepharoplasty. In this procedure, we sculpt the fat pockets from the inside of the eyelid and then re-position it. By doing that we reduce the protrusion and the natural contour and shape of the eye is restored. No one would be able to tell that you had surgery because there are no outside incisions. We often combine this procedure with the application of injections called platelet rich plasma which helps with skin discoloration. This is derived from your own blood that is spun down. It is then injected under the skin to improve skin quality and the luster of the skin. It also helps with dark circles.

 

I hope this was helpful to you, and thanks again for your question.