I Am 30 Years Old and Have Dark Eye Bags Under my Eyes I Have Visited a Surgeon Who Has Recomended Transconjunctival? (photo)

I am 30 years old & have bad dark eye bags under my eyes I have visited a surgeon who has recomended Transconjunctival I would like some advice and have have attached photographs. I live in London United Kingdom & hope you can help with some advice. I have always had dark circle under my eyes but they have become puffier and more pronounced as I have become older and would like to have them look better as soon as possible. I am realistic with how much I can achieve but hope they can be improved

Doctor Answers 4

Transconj approach

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The proposed technique is an excellent one to treat the herniated fat as it does not result in a visible scar on your eyelid.  Sometimes a small pinch of skin improves on this procedure so the scar is still present but it fades nicely in all cases.  Best wishes!

Your underlying flat cheek anatomy predisposed you to this condition

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Hello there!  Your question and situation is a good one, and is also quite applicable to many other patients. 

The under eye region is intimately related to the cheek anatomy.  Your cheek anatomy is relatively flat, and this predisposes you to the tightness below the "fat bag"  If you place your finger on the hollow below your lower eyelid fat bag, you will feel the  bone just a few millimeters below the skin.  The fullness of the lower eyelid has not changed in your lifetime, but the loss of soft tissue volume (which is one of the hallmarks of aging) has unveiled your orbital rim hollow.  It is as if a valley has developed adjacent to a hill, making the hill look higher than it really is.

You have several options.  The first is to consider non surgical filling to the hollow, which can be a very satisfying low downtime procedure, especially if the filler is injected with a cannula instead of a needle.  

Surgical options include options for treating your cheek (which is where the underlying problem really lies) and your eyelid fat.  I would discourage you from having a simple transconjuctival fat removal procedure, as this will reduce the eyelid fat bag, but do nothing for the cheek volume loss/ flattening or the orbital hollow.  A fat transposition procedure would release the ligament that causes the hollow and redistribute the eyelid (orbital) fat inferiorly, improving your cheek contour permanently. This could be done with fat transfer to the cheeks to further treat the soft tissue volume loss of the cheek that has unveiled your problem.

A final thought- only if you feel that your flat cheek anatomy is something you have always wanted to change- is to consider a cheek implant while working with the eyelid fat.

Good luck!

Tanuj Nakra, MD, FACS
Austin Oculoplastic Surgeon

Dark circles and puffy eyes

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A transconjunctival approach will take out the the herniated fat.  If there is excess skin after the bags are removed a small amount of skin may need to be removed on the outer lash line.  This is known as a pinch technique and the skin is closed with Histocryl tissue adhesive.  No sutures required.  The decision to remove any skin would be made at the time of the consultation and physical exam  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Lower Blepharoplasty

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Based on your photos, you need a Lower Blepharoplasty.  Without an evaluation, I cannot determine which way I would approach this.  In the photos you appear to have fat pockets and excess skin.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 61 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.