Treatment for bad double under eye bags? (Photo)

You need an actual examination where the doctor actually physcially examines the projection of the orbital rim and how your herniated orbital fat drapes this area.  A consultation from the door of the consultation room is not going to cut it.  There are three basic options here with numerous variations.  The first is chemically peeling the lower eyelid skin with phenol 89% which would help tighten the lower eyelid skin holding the orbital fat back.  The second options is transconjunctival lower eyelid blepharoplasty with arcus marginalis release.  This transfers the herniated orbital fat into the top of the cheek solving the lower eyelid fullness and the relative hollow at the top of the cheek.  I would not recommend a transcutaneous lower eyelid blepharoplasty.  This will wipe out your orbicularis muscle roll just below the lower eyelid lashes.  You may not like this now but you will not appreciate this feature being wipe off your face (think Rene Zellweger).  The key is less is more. You want what makes the most sense for your features and for your comfort level.

This area is best treated with fillers and lasers .  Microneedling/PRP and skin care help.  Best, Dr. Emer.

Bags under the
eyes are frequently the first signs of aging displayed on the face.  There is a strong hereditary component
to lower eyelid ‘bags’.  Lower eyelid blepharoplasty is a surgical procedure to remove or
redistribute the fat to remove the bags and hollows under the eyes.  This is generally considered a
permanent or very long lasting solution.  If only fat is present the procedure can be performed without any
visible incisions or cuts on the eyelid.  This is called a transconjunctival blepharoplasty.  If excess skin is present, then a small
incision under the lash line is performed.  This incision generally heals very well.

Alternatively if
a patient is fearful of surgery or doesn’t have the ability for the week of
downtime or the recovery associated with surgery then fillers can be used.  A hyaluronica acid, usually Restylane,
is injected in the office to minimize the hollows or depressions around the
eyes.  Lasers can also be used to
tighten the lower eyelid skin.  There are many treatment options for the eyelids and I would recommend a
full consultation to see which option is best for you.

It is difficult to see in the photo but there appears to be still under eye bags (fat and skin).  See an oculoplastic specialist for evaluation. See link below.

Thank you for sharing your question and photos. Under eye bags can be improved with injection of dermal fillers for mild cases (Restylane is the best) or through surgery in more severe cases. It is difficult to judge the degree of buldging in your case. Please see an experienced eyelid surgeon in person for comprehensive evaluation and discussion of treatment options.Good luck,

You are likely a great candidate for a lower eyelid blepharoplasty. You do need an examination to ensure that you do not have risk factors for an ectropion which include:1)loose lid tone2)weak malar prominence3)enlarged eyeballs4)dry eyes

Dear K-kat:Hard to see enough detail  from one front-view photo, but it looks like your lower lids did get the double whammy!I'm pretty sure that lower lid blepharoplasty, with mostly skin excision (but also just a bit of fat excision too) would help immensely. These can be done under local anesthesia  with some oral sedation and take 60 to 90minutes to perform, and will last for years. How long it takes lifted areas to sag again is determined by heredity and, honestly, needing an eyelid lift at 35 might well mean you could expect that a repeat would be in your future sometime. See a board-certified  plastic surgeon for advice-- and Good Luck !James  H. Scheu. M.D.