I'm 34 yrs old and have had bags under my eyes for years (it's hereditary) Will tear trough injections help in my case? (photo)

I don't like the sound of a full surgical procedure, but have seen some pretty unsuccessful tear trough before and after photos. Would love some advice before I start spending on costly consultations.

Doctor Answers 10

Unforunately even surgeon's posting here do not understand that your issue is best addressed with fillers.

Put your finger on top of the "bag."  The firm thing you are feeling is not herniated orbital fat.  The thing you are feeling is your bony orbital rim.  Eyelid surgery does not fix that.  Surgeons who suggest that you should have surgery for this are simply ignorant.  This issue is beautifully addressed with hyaluronic acid fillers.  The most critical aspect of this service is finding the right injector.  Don't get coerced into a surgery you don't need.


Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Tear trough filler

Having filler placed there won't make the tear troughs go aways completely, but if done correctly it can have a dramatic effect. I've had a lot of happy patients who are your age with fillers in the tear trough. Because it's less invasive and has minimal downtime, injectables are a great alternative to surgery. The tear trough can be a difficult area to inject, so make sure you are seeing someone with a lot of experience specifically in this area of the face.

Eyelid Surgery

Thank you for your question. There are potential options for addressing your under-eye bags, including the eyelid surgical option (most effective), fillers and ointments. I suggest that you consult with a single or board certified facial plastic surgeon.Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 95 reviews

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Surgery can be performed to remove the fat in this area or reposition it but i find that fillers, lasers, microneedling/PRP help without surgery.  Best, Dr. Emer.

Jason Emer, MD
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I'm 34 yrs old and have had bags under my eyes for years (it's hereditary). Will tear trough injections help in my case?

Hello teartroughdreamer - Thanks for your question.  Without examining you, everything said here is just opinion.  If you do have excess "bags" they can be removed or repositioned with blepharoplasty surgery.  If the problem is that you have a negative vector to the inferior bony orbital rim, then filler can be helpful to build up the rim's projection and camouflage the teartrough.  I would recommend that you consult with an eyelid surgery specialist who also has expertise with periorbital filler.  This is essential.  Also, make sure they use cannulae instead of needles for enhanced safety. Good luck, Dr. Shah 

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 47 reviews

Fillers can help

Fillers can help and are worth a try to start.Surgery (blepharoplasty) will release the lower band and allow your own fat to help fill the hollow.

Eyelid Bags

Thank you for sharing your case and photos.  I can definitely see the puffiness that may bother you, but it is hard to judge which treatment would be best because you are looking down in the photo.  It's best to examine you in all fields of gaze and to the side to make sure I can recommend the best treatment for you.  In general, fillers are a good way to start, but ultimately I think the blepharoplasty will be necessary.  Schedule a consultation with an oculoplastic surgeon to discuss your goals.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 24 reviews

Eye bags - best way to correct

Thank you for asking about your lower lid bags.
  • The best treatment by far is a transconjunctival lower lid blepharoplasty to remove the visible fat.
  • The procedure does not leave a visible scar.
  • It can at times be done with local anesthesia in the office.
  • Tear trough fillers have unpredictable results - and it is a risky area for fillers.
  • And will soon cost much more than surgery because results are temporary
  • See a plastic surgeon or opthalmoplastic surgeon for permanent correction with surgery.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Will Facial Injections Help Improve My Eye Bags?

Hereditary eye bags in Caucasians are probably due to a genetic predisposition to have a weak septum orbitale which allows fat in the lower eyelids to come forward, pushing on the muscle and skin, and giving what is known as an eye bag.
The tear trough itself occurs once the facial skin under the eye begins to descend down the face secondary to the aging process.  This uncovers the orbital rim and the hollow between the eye bag and the descendant skin is known as a tear trough.  
I am not a big fan of injections into the tear trough which is just the edge of the orbital rim and thin skin covering it.  These injections most often do not blend with the descending skin below and the bag above, therefore leaving the injected area looking worse after the injection than before.  
If you were my patient, I would recommend Voluma, a highly crossed linked HA injected below the orbital rim which acts to push skin and subcutaneous tissue upward over the rim and up to the descending eye bag (fat).  This fullness created by the Voluma often gives a very smooth transition between eyelid and cheek skin, and therefore eliminating both the tear trough and the appearance of eye bags.  
Voluma is not expensive when you consider how long it lasts, vis-a-vis other HA facial injectibles.  Since the headquarters of Allergan who produces Voluma is in Ireland, I can only assume there are many excellent Voluma injectors in your neck of the woods.  

Eye Bags Treatment

Looking at your photos I would suggest a trans-conjunctival blepharopalsty.  This would be an excellent, permanent solution to your eye bags.  You could try injectable fillers first, but in my experience, I don't think this would be the best option.  I would have a complete evaluation by an oculoplastic surgeon.  A hands on exam is always best when deciding on a treatment option.

Jessica Lattman, MD
New York Oculoplastic Surgeon
5.0 out of 5 stars 27 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.