Bags and Sagging Skin - What Can I Do to Fix This?

Hi. I am 29 years old. I have 3 children and i feel like i'm 19. My face however says something completely different. My cheeks are flat and my bags under my eyes are Horrible to say the least. I need help. I feel i am to young for a face lift but i need to do something and fast i will have no pictures of myself with my children if i don't fix this. Please help...

Doctor Answers 15

Under eye bags and flat cheeks

Bags underneath the eyelids at a younger age usually indicate either a genetic predisposition to puffy eyelids or allergies.  Uncontrolled allergies can cause significant puffiness in the lower lids, which are best treated medically with nasal sprays and antihistamines, not surgery.  If there are no allergies or the allergies are medically controlled and the puffiness still exists, then usually a transconjunctival blepharoplasty can be performed to remove fat pads underneath the lower lids.  There are 3 fat pads in the lower lids that need to be addressed through a transconjunctival approach.  Flat cheeks are best addressed with cheek implants made of silastic.  The implants are placed through an intraoral incision above the gum line onto the maxilla to augment a flat cheek area.  

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Periorbital fat

You appear to have herniation of post-septal fat or periorbital fat.  This is treated through anterior or posterior approaches to remove some of the fat. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews

Lower eyelid bags-treatment

Based on your photos and your age, it appears you have excess fatty tissue in your lower eyelid area which is a genetic condition more than an aging issue.  I would recommend repositioning the fat, not removing it, in order to recreate the smooth transition from your eyelid to your cheek area.  I would also consider augmenting your cheek area with a small amount of fat which can be harvested from your abdomen.

Consult with a board certified plastic surgeon for a more in depth examination and evaluation.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 377 reviews

Lower eyelid fat bags and weak cheek bone structure

Judging from your photos you are an excellent candidate for a lower eyelid procedure (Blepharoplasty).  This can be approached through an incision on the inside of the eyelid resulting in no visible scars.  In situations like yours where there is also a weak cheek bone structure,  a combination of fat repositioning and fat removal is indicated, so that your lower eyelids would not end up looking hollow.   You would also benefit from enhancing your cheek volume, and this can be done a number of ways.  The most permanent would be cheek implants or fat transplantation, but fillers such as Radiesse or volumizers like Sculptra can also be used, but they will need to be repeated over time.  Your surgeon would discuss the options so you could make an educated decision.

Keith A. LaFerriere, MD (retired)
Springfield Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Fat Transfer and Blepharoplasty for Midface Rejuvenation

I have reviewed your pictures and agree with your concerns.  The lower eyelid bags are fatty deposits which are providing a "bulge" to your lower lid.  A conservative removal of the lower eyelid fat will allow the lower lids to appear smoother, but not sunken.  This can be achieved with a transconjunctival blepharoplasty which is performed without any visible incisions (all incisions made on the inside of the lower lid).   With regard to your cheeks, I do agree that they are "low" on volume.  Fat injections provide a minimally invasive way to add volume to the cheek, without the need for artificial implants.  Good Luck... Dr. Corrado

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 35 reviews

Lower eye lid surgery would be best

Hi. Looking at your photographs I would think that  the "bags" under your eyes bother you the most. It is usually caused by fat. It appears from your pictures that the bags are too large to be corrected by Restylane injections alone. If this is true the best treatment would be a Blepharoplasty ( lower eye lid surgery to remove the excess fat only). This will dramatically make you look more youthful. I think your cheeks fit your narrow face but if you want more fullness, I would use a filler such as Restylane or Radiesse to determine the look desired. I'm glad you feel 19. Good luck

Sheila Bond, MD
Montclair Plastic Surgeon
4.4 out of 5 stars 40 reviews

Cheek Implants and Transconjunctival Lower Blepharoplasty To Improve Tired Look

You are an excellent candidate for cheek implants and a transconjunctival (inside the lower eyelid incision) lower blepharoplasty. (fat removal only) You have no excessive skin, just lack of cheekbone prominences which magnifies the herniated lower eyelid fat. Both procedures are done without any external incisions as cheek implants are done from inside of the mouth and the fat removed from inside of the lower eyelid. These two procedures together will make for a non-tired look to your eye area.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Your right

i think your personal asessment while a little harsh is basically correct. i also favor the transconj approach for fat removal and think it is your best choice as this really unrelated to age. as for your cheeks, sculptra is my first choice. my wife and i looked like that when our three kids were all under 3 (twins +1). if you can hang in there it gets easier and rest may not make you look better but you will definitely be better rested. good luck.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

Eyelid surgery and cheek implants would improve your look

You have bags in your lower eyelids, relatively flat cheeks and a thin upper lip. If you had a lower eyelid surgery, Cheek Implants and filler or a lip implant for Lip Augmentation....this would address all of your concerns. You do no have evidence of excess skin, on the face, and as such are not a candidate for a Face Lift of any kind. Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Flat cheeks and bags under eyes.

These can be improved dramatically with cheek implants and removal of the lower eyelid bags, which can be done with th incision inside the eyelid.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 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.