What is the best solution for my under eyes? (photos)

I'm 34 years old and have puffy under eyes,but my left under eye is more puffy than the right one, what is the best solution for it? The temporary and the permanent? And what is the cost for each procedure? Thank you

Doctor Answers 8

You have a negative vector cheek- it does not project strongly.

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Than means you have less support for the lower eyelid than others.  What you should not do is have a transcutaneous (skin incision ) lower blepharoplasty.  If you have surgery, you should have tranconjunctival (behind the lower eyelid incision).  The most powerful option would be transconjunctival lower eyelid surgery with preservation of the fat which is rotated into the top of the cheek (arcus marglinalis release surgery).  If you are uncomfortable with surgery, filler would be an option but your eyelid will be challenging to fill and it will require a significant amount of filler (3-4 milliliter) and only an expert injector will be able to help you.  Whatever option you elect, the most important thing is finding the right cosmetic surgeon.  We are not created equal.  Who you choose to see will make all the difference in your outcome.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Puffy Lower Eyelids

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Your photos are helpful, but an in-person consultation would help best.  Your midface descent is accentuating the prominence of your lower eyelid fat "bags."  You may also have a negative vector midface, which can be hard to improve.  Possible suggestions to help include a hyaluronic acid filler for your lower eyelids to smooth the transition between the baggy areas and your cheek.  Lower eyelid blepharoplasty can also be done from inside the eyelid to remove/reposition the fat bags to smooth the appearance.  Some patients can be benefit from midface implants though I don't many surgeons that place these very often.  Midface lifting can also help smooth the transition between the cheek and your eyelids making the lower eyelids look smoother.  I think your concerns warrant a well experienced surgeon.  In your area I would suggest consulting with Plastic Eye Surgery Associates (Drs. Charles Soparkar and Jamey Patrinely), who have and remain very well respected for the last 20+ years in Houston.  Best regards.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Bags under lower lids

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I think the best solution for your particular problem is a transconjuctival lower eyelid blepharoplasty and a suspension of the orbicularis muscle.  This will improve some of the droopiness of the lower lid.  Additionally  resurfacing the skin will improve the color and texture which should brighten the overall appearance of the lid.

J. Kevin Duplechain, MD, FACS
Lafayette Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews


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Thank you for your question. I suggest that you consult with a board certified facial plastic surgeon for an in-person examination to learn your problem in the lower eyelids. If the only problem in your lower eyelids is removing excess fatty tissue, then this can often be done with a laser and no external incision needed. If the excess fatty tissue has resulted in stretching of the lower eyelid skin, then a traditional blepharoplasty with an external incision is needed.Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Lower eye bags...

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The dark circle that you see under your eye is actually a shadow being cast by by a small bulge of fat that has formed over time. There are two ways to address this. One option is non-surgically with fillers like restylane or belotero. The filler would be placed in the shadowed hollow so that it would be at the same level as the fat bulge to camouflage the problem. This would need to be repeated every 9-12 months or so. The other option is surgical. It would involve removing the excess fat so that the bulge is reduced to the level of the shadow. This is a longer lasting option and can be done under local anesthesia. I would recommend consultation with a facial plastic surgeon or plastic surgeon. I wish you well!

Parker A. Velargo, MD
New Orleans Facial Plastic Surgeon
5.0 out of 5 stars 52 reviews

Best solution for under eye bags

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The best solution for under eye bags is a trans-conjunctival approach lower blepharoplasty.  This involves placement of the incision only on the inside of the eyelid and removal of the fatty deposits creating the puffiness look.  The procedure is performed under a brief general anesthetic as an outpatient surgical procedure.  For more information and many examples including our current price list, please see the link and the video below 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

What is the best solution for my under eyes?

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Hello Maria moca,There are several options for treating under eye bags.  The bags do two things.  They create puffiness around the eyes and they also create a shadow where the bag ends right before your cheek starts to show.  This creates a finding called the tear trough deformity.  This bag is caused by fat that is normally found around the eye but in some patients it is more prominent and with time the membrane that holds them back weakens and causes the bags to push out more.  You can use makeup to help conceal that shadow that is created in the tear trough.  This does not treat the underlying problem which is the bag, and with time more and more makeup is needed which creates a cakey look.  The next option is to use temporary fillers.  I like to use Restylane.  These are injected along the tear trough to help raise the skin up in that area.  It helps to better camouflage the bags and make the tear trough not as deep.  This also improves the shadow that gets cast there.  This is a very popular option, especially among younger patients.  The final option, and most effective is surgery to remove the bags.  There are three possible surgical approaches to that area.  Since you don't have any excess skin I would recommend you consider the approach that goes through the pink part of the eye (called transconjunctival).  This doesn't leave any external scars, but still lets you address the fat bags.I'd recommend you consult with a facial plastic surgeon to learn more about your options.I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Treatment for puffy lower eyelids

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Thank you for sharing your question and photos. It is difficult to determine the best method for treating your bags. There at surgical procedures (blepharoplasty) which can correct puffy lower eyelids and non-surgical methods (fillers). See an experienced eyelid surgeon for comprehensive evaluation and discussion of potential solutions.  Good luck,

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.