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

    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.

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.

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.

When people have bags under the eyes from hereditary causes, it frequently will appear in the 20's and sometimes even earlier.  Your options would be to have lower blepharoplasty to remove some of the fat, or you could have an injection with a filler, like Restylane, below the bags to conceal them.  

Under eye bags (pseudoherniation of orbital fat) is a common complaint.  The eye area is one of the first areas of the face to show aging changes.  As the thin lower eyelid weakens, the fat pads are able to bulge/push forward and show up as bags, starting as early as your 30s or earlier if lower eyelid bags run in your family.       
There are many options for under eye bags.  Each surgeon will have a different approach and technique based on experience and training.  The degree of under eye puffiness/bags (mild, moderate, severe), for me, is the most important factor when it comes to deciding on options.  
If the bag is mild and associated with a tear trough deformity/hollowness (it appears that you have some mild tear trough hollowness), my favorite option is a filler.  The filler is temporary but when placed deep and conservatively by an experienced injector, the risk of irregularity or migration is very low.  Fillers are great options for patients who aren't interested in the downtime from surgery and who want an immediate result.  Most fillers in the US are FDA approved for 21 years and older.  
Lower eyelid lift (blepharoplasty) is an option for you with long-lasting results.  I don't usually recommend surgery as the first option in younger patients.  There are advantages and disadvantages of surgery.  For some patients, especially younger patients who don't need to have excess skin removed from the lower eyelid, an incision can be done on the inside of the eyelid to avoid any scars.  The surgeon conservatively removes the part of the fat pad that is showing.  This results in a flatter lower eyelid.  If you have some hollowness under the eye, the surgeon can reposition the fat pads to blend the area.  The best way to piece these options out is to make a consultation with a qualified surgeon.  You may also consider a consultation with an allergist or primary care physician to discuss possible underlying causes that could be making the bags worse.  

Good question! Thank you for thephoto that you have attached. Based on that photo, you seem to have darkcircles and under eye bags. These two can be resolved by first undergoingnon-surgical procedures such as dermal fillers. I often advise my clients to gonon-surgical especially if their case is a mild one since non-surgical methodscan usually resolve the issue.
Fillers can help by improvingthe bags and dark circles. Fillers conceal the bags so that the dark circlewould lighten a bit. The result with fillers always looks natural making youroverall appearance look youthful. Fillers are also very affordable. However,since fillers are temporary and they do not really remove the eye bagspermanently, you may need to maintain this by undergoing filler treatment aftera year. Surgery would be a good solution if your eye bags are severe and if youwant to permanently remove them. This surgery is called blepharoplasty. This isexpensive though and has longer downtime.
If you have decided to repair your undereye bags, visit a board certified plastic surgeon so he or she could develop anappropriate treatment plan that would cater to your needs. Best of luck to you!

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.