What is the best treatment for my dark under eye bags? (Photo)

I am 24 years old Filipino and have a distinct Filipino dark puffy eye bag look. I'm healthy, water drinking, fit individual. Bags are more apparent when I smile. Adds years to my face. I'm looking for a permanent solution without the worry of make-up washing off when it rains or during summer time swimming. Help!

Doctor Answers 4

You don't have eye bags that are always present - the puffiness is caused by the contraction of your lower eyelid muscle

Thank you for your question. I understand you have some concerns regarding dark under eye circles and eye bags that become particularly prominent when you smile.

To give you a bit about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. Dark circles and eye bags are things that I deal with regularly in my practice so I can certainly assist you with this.

When people come to us with eye bag concerns, it’s usually due to eye bags that are constantly present on the face regardless of the facial expression. This type of eye bag is caused by lower eyelid fat prolapse, where the fat that’s normally around the eyes pushes forward and creates this bulge. We address this by performing a transconjunctival lower eyelid blepharoplasty, which allows us to reposition the fat pockets through the inside of the lower eyelid.

Sometimes, people will come to us with a situation where they don’t have bags when their face is relaxed, but have what they perceive as bags when they are smiling. This is caused by the contraction of the orbicularis oculi muscle, which is the muscle that supports the eyelid and is responsible for the position as well as blinking. When this muscle contracts, it bunches up and the skin bunches up as well, creating the appearance of a bag.

I always try to explain to patients the importance of this muscle as a baseline for proper eyelid position. It is possible to get some improvement by relaxing the muscle with a bit of Botox, keeping in mind to be sure to retain muscle tone in order to still provide proper support for the lower eyelid. However, the outcome may not be dramatic or significant enough to justify the cost and the maintenance that comes with it.

From my own artistic or aesthetic perspective, I don’t find these types of issues to be a problem. I think that it’s part of the look when someone smiles to have the bunching. A smiling face is always an attractive face. If you are adamant about it, you can consider Botox, however I’m always hesitant in performing such procedures on much younger patients.

When it comes to dark under eye circles, what I normally do for our patients is use platelet-rich plasma, a concentration derived from the patient’s blood which stimulates collagen and improves skin quality, and combine it with a hyaluronic acid filler to address under eye hollows, which fortunately you don’t have.

In your case, being so young and having functional normal tissue, I’m very hesitant to suggest that you pursue aggressive treatment. If you want to experiment, I think drugs like Botox™ and Dysport are safe and can be done just to satisfy your curiosity but otherwise, I would say that you can either meet with qualified experienced doctors so that you can learn more about your options, or you could just hold off doing anything at all for a few more years.

I hope that was helpful and I wish you the best of luck!

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New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Filler

A HA filler such as Restylane can fill in the hallow under the eye, restoring "plumpness" which will diminish the appearance of dark circles. However, if will not fix the dark pigment under your eye so you probably still need to wear makeup. Schedule a consultation with a board certified plastic surgeon in your area to be assessed in person and discuss whether or not filler is worth it for you. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 51 reviews

Filler

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 87 reviews

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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.