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

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

With your mild tear trough hollow (dark circle) and bags, you are a good candidate for undereye filler or lower blepharoplasty. In skilled hands, either can achieve a beautiful result in your case.

If you are looking for a cost effective, minimally invasive treatment, consider the filler approach, knowing you'll have to repeat if every year or two.

If you are open to surgery, lower blepharoplasty with fat transfer to the tear troughs is the best answer.

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.

First of all it is important to control your allergies with nasal sprays , antihistamines and allergy testing if the medications don't help.  If your allergies are under control and the bags are still present, a conservative transconjunctival lower blepharoplasty can be performed to get rids of the bags 

Blepharoplasty can be a useful procedure for any age starting in the teenage years.  Since the results last for many years it does not pay to wait.

Fillers or fat injections below the lids are other less aggressive options.

Please consult with a Board Certified Plastic Surgeon prior to making any treatment decisions.

    Temporary fillers like Restylane could be used to give an idea of the type of improvement to be expected.  Facial fat grafting can be used as well in the hand of an experienced surgeon.

Dear srowan08,

I agree with some of the other posts that filler can somewhat camouflage the bulging of fat through the lower eyelid by filling in the hollow below it. However, the camouflaging effect will mainly be present only while you are not making any facial expression. When you do make facial expressions the fat will still bulge and be noticeable. I tend to be very conservative in my treatment of patients and do not push surgery, however, the only way to completely rid yourself of the bulging would be through removal of the fat through the lower eyelid. If surgery is not something you wish to pursue, certainly filler can be used to help, as I mentioned.

Hope this helps.

Good luck!

There is no reason you can't have a blepharoplasty at your age, given that the bags aren't going anywhere! However, if you're busy or want to try a "trial run" first, fillers like Restylane or Radiesse can tide you over until you're ready for a surgical alternative. Just make sure you seek the help of an experienced physician, as injections around the eyes are tecnically challenging and best left to experts.

Hi SRowan.  At your age, we would likely suggest Restylane.  Injecting the under eye area with Restylane can go a long way toward addressing your concern.  It is much more affordable than surgery and lasts up to 1 year.  

Fillers would be a good first line option for you [by an experienced injector]. If you wanted something more permanent, a lower lid blepharoplasty with fat repositioning would be my recommendation. This would reposition the fat from the bulge above into the hollow just below [tear trough] and minimize chance of lower eyelid hollowing as you get older.