Need direction as of what to do about under eye area (Photo)

I have attached pictures. 1 not smiling and then 2 smiling. I don't like what I see at all! I am 33 with pretty good skin except my under eyes! Over night my under eyes have changed. They are always swollen and I look tired. People ask me all the time! I am wondering if surgery would be best or fillers. Or is there any cream, peel or laser that would help this?

Doctor Answers 10

Under eye bags and dark circles (hollowness)

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You have under eye bags (orbital fat prolapse) plus hollowness underneath it.  The best option with long lasting results is transconjuctival lower blepharoplasty with fat repositioning. See following link and video.  Another option is filler injection but less effective and short term given the bags you have. See an oculoplastic specialist.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Eyelid Surgery

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It is hard to definitively diagnose a problem from a picture and I would recommend seeing an oculo-plastic surgeon which is an ophthalmologist with a concentration in plastic surgery specifically around the eyelids. That being said, it looks to me that you have what is called ectropion.

That being said it does seem from your pictures that you do have fat prolapsing forward beneath your lower eyelids.

Treatments for this include fillers in order to soften the appearance of the bags or a lower lid blepharoplasty with fat excision to remove the excess fat. Only a consultation with an oculo-plastic surgeon can determine which would be better for you.

Dan Landmann, MD
Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 46 reviews

Fillers Can Work Well For Under Eye Bags With Immediate Results

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My last patient this morning before my lunch break had exactly the same problem you describe. It was easily, and with immediate results, treated by injecting a filler to mask the incipient bags I prefer Belotero Balance for this purpose in my Upper East Side Manhattan practice, since it possesses little to no tendency to give rise to the unwanted, bluish Tyndall Effect when injected superficially into the delicate tissues under the eyes. (In my Israel satellite facility, where a far greater number of regulatory agency approved fillers are available , I typically opt for Teosyal Redensity II for this region).. The treatment took no more than three minutes to complete and the patient literally blew a kiss at herself when looking at the mirror right afterward, while commenting to her reflection in the mirror flashing a big smile of delight, "It's the way I used to look."  This is not a region to be left to novice injectors and medspas, So make sure that you consult with a board certified aesthetic physician before proceeding, and most definitely request to see his/her before and afters before agreeing to proceed. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Need direction as to what to do about under eye area

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 From the limited photographs, there appears to be herniated pads in the lower lids. A trans conjunctival approach with incisions placed on the inside of the eyelids can accomplish removal of the fat bags causing the puffiness. If there  is the excess skin at rest rest( not upon animation) an incision is placed at the eyelash line  to tighten lower eyelid skin. For more information and many examples, please see the link and the video below

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

Lower eyelids and tear trough area

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You have fantastic cheek bones, and minimal fat pad prolapse, a great foundation for a little filler and laser. I see many patients considering lower lid blepharoplasty who are pleased with a less aggressive, less invasive alternative. Filler in the supra-periosteal location along the zygoma (Juvederm Voluma XC) and CO2 laser resurfacing to gently tighten the skin would reduce the tear trough depression. This combination may give you years of great results to enjoy without the risks associated with blepharoplasty surgery. Best wishes with your decision.

Sara A. Kaltreider, MD
Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 12 reviews

Lower lids

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I would recommend that you see a surgeon that specializes in "only faces" and is familiar with a technique known as the "SOOF lift blepharoplasty". In my opinion this approach is the gold standard for the lower lid. See the video and good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Thoughtful eyes

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You have very nice skin and pretty eyes. Particularly while smiling. That is helpful in this process! There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  

1. Prolapsed orbital fat through the orbital septum (less likely in young people): treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Ezcema: much more common in young people with fair skin. I believe this is your issue. The treatment for this is to hold off on make-up and any manipulation of the lower lid (allergies?) for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist. This would be ideal for you to have both opinions.

3. Fluid accumulation and/or redundant skin. Could be possible in young but would need a good facial analysis and exam to determine. Could treat with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. Unlikely in your case but can happen. Treated with mid face lift or fillers.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Need direction as of what to do about under eye area

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Without the benefit of physical exam- it's difficult to comment accurately. From your photos it appears that you would benefit from a lower lid blepharoplasty. Seek an experienced Board Certified PS for in person exam

Lower lids may be treated by surgery or fillers

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Aging lower lids are the result of loss of skin elasticity, fat herniation, and loss of volume. Each of these must be treated accordingly after the correct diagnosis is made. In mild cases, a filler may be all that is needed. If skin is crepe, skin care or peels/laser treatments can tighten the skin. If fat herniation is severe, surgical excision needs to be performed. 

In a 33 year old with very mild herniation, I would try fillers first. Having said that, filling the tear troughs is a technically difficult procedure and only seek treatment by an experienced injector.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Treatment of under eye area

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Looking at your pictures, it appears that there may be some fullness under your eyes caused from protruding fat.  This can be improved with the use of fillers under the fullness to camouflage the puffy area or surgery can be done to address the protruding fat directly.  The surgical result would be much longer lasting than the result from fillers.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.