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

I am 22 years old and have been cursed with the genetic fatty patches underneath my eyes - causing pretty bag bags (for my age). They get worse when my allergies act up and are pretty impossible to conceal. I am constantly asked if I am tired or sick, and just feel as if they are a burden. I've been doing some research on blepharoplasty, and was curious whether or not you'd recommend that for someone my age. I would love to hear your opinion on whether this would be an option for me! Thanks so much.

Doctor Answers 11

Treatment of bags and dark circles in younger patients

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.

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 170 reviews

Temporary and Permanent Treatments for Eye Bags

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.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Tired eyes

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 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

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Blepharoplasty, young age

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.

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 19 reviews

Filler or Fat Grafting to Tear Trough

    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.

Lower Eyelid Bags- Treatment

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!

Eye bags at a young age

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.

Cameron Rokhsar, MD, FAAD
New York Dermatologic Surgeon
4.5 out of 5 stars 35 reviews

Restylane for Eye Bags

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.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Fillers would work or....

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.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 32 reviews

Fillers are definitely they way to help this for now.

However, and this is the rub, it must be done by a very experienced injector.  Under eye treatment is really an advanced technique.  Artistic ability and the ability to adjust the service with hyaluronidase if necessary is critical.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 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.