Considering lower blepharoplasty for genetic eyebags. Would fillers be a better option because of my age? (Photo)

My mom says she had eyebags even as a child. Now she is 50 and trying to get a lower blepharoplasty, since they have worsened in the last few years. I also have had eyebags as long and I can remember and I would like to get treated. I also have chronic allergies, which make them worse. Would a blepharoplasty be the best course of action for me, or would fillers be a good choice for my age and type of eyebags? I'd rather get a lower bleph, because that will be permanent. But again, my age is a factor.

Doctor Answers 6

Genetic eye bags do run in families and can affect young people. Choosing a filler or surgery can be assessed.

As a practicing oculofacial plastic surgeon for 20 years, I have operated on people as young as 14-years-old for bags under the eyes. Eye bags runs in families and I’ve actually operated on 3 generations in the same family. There are some key important factors that will help you decide which option is right for you. The first is how prominent the bags are. In your photo, it appears that they are relatively prominent, but lighting and other factors can impact how 3-dimensional the bags are. If the bags are very subtle, then they may be camouflaged with a filler like Restylane or other hyaluronic acid. But if the bags are more prominent especially when you look up, and they bulge forward and become even more prominent, then you should consider a lower eyelid blepharoplasty. In a younger person like you, I would typically do a transconjunctival blepharoplasty.

In addition, allergies accumulate a lot of fluid in the eye area. Management of allergies is very important when you are considering rejuvenation of the lower eyelids. If your eyes are itchy or if you have watery eyes and you need eye drops, those things should be managed. If you need to take antihistamines, then take them. Allergies can still affect the appearance of your under eye area.

When the puffiness is removed, even if you have allergies, it won’t look as puffy as when the fat pockets were there. You are probably best served with a blepharoplasty as opposed to using fillers. But as mentioned, 3-dimensionality is something that can only be appreciated in a physical examination.

Skin quality with allergies is also an issue so you have to think about good topical skin care. Sometimes people with chronic allergies rub their eyes a lot and the skin becomes irregular and has an aged appearance. In our practice, we would routinely do a platelet-rich plasma injection and the use of fractional CO2 laser. However, it is important first to do a physical exam.

If your mother is doing her research, it will be good for you to tag along and have a consultation. I recently did a facelift and eyelift on a mother and daughter and they supported each other very nicely during their healing process. This is worth considering when you do your consultation. Most importantly, understand the level of fat prolapse you have. If it’s beyond a certain level, you’re probably best served with a lower eyelid blepharoplasty. I hope that was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Lower Blepharoplasty at young age

You don't mention your age, but obviously, you are quite young.  I think the camera angle and lighting are probably making the hollows under your eyes look more prominent than they typically appear in -person. 

You certainly are not a candidate for lower blepharoplasty. I find the result of fillers under the eyes unpredictable at best, and sometimes disastrous. At some point in the future, you might consider conservative structural fat   grafting  performed by a plastic surgeon with considerable experience and expertise in creating lasting and natural looking results from this procedure. 

At this moment, the best option might be the use of make up under your eyes.  

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Genetic Eyebags

Thank you for your interesting question.  You are obviously young.  And, your mother reports a history of "eyebags" in her youth as well.  This is an important part of your history.  Older people get bulging fat bags as a part of the aging process.  In contrast, young people get protruding fat bags because of an anatomic condition called a tear trough deformity or malar hypoplasia (under-formed cheek bones).   Because your cheekbones do not adequately protrude, the fat under the eyes casts a shadow and gives the appearance of protruding fat bags.
So, your fat bags are actually the normal part, and the under-formed cheek bones are the abnormal part (which makes your fat bags look abnormal).

Understanding your condition helps you to understand the proper treatment which will give you the most permanent and lasting correction.  This usually means building up the cheekbones (infra orbital rim) by filling in the tear trough with fillers or a tear trough implant.  The following reference will help you understand your condition. 

Beware of a traditional blepharoplasty which removes fat from under the eye.  Since this does not treat the primary pathology (under formed cheekbone), the bags often recur; or after the passage of time, you may develop a hollow appearance to your eyes (which does not give a youthful appearance).

Good luck to you.  I would recommend a consultation with a board certified plastic surgeon.

Gilbert Lee, MD
San Diego Plastic Surgeon
4.8 out of 5 stars 22 reviews

Considering lower blepharoplasty for genetic eyebags. Would fillers be a better option because of my age?

Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers like Restylane, micro-fat grafts, and blepharoplasties. There is no one best procedure. Each has benefits and potential drawbacks.

Following the advice of anyone who would presume to tell you what to do based on limited 2 dimensional photos without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Restylane for Under Eye Bags

Hi LoftheL.  You are an excellent candidate fro Restylane injections around and under the eyes.  We prefer Restylane in this area because it is a soft filler that works very well with the thin skin and facial anatomy in this area.  It can help with the contour of the area (filling it out) and also improve the color.  

To see other Orange County patients pictures that have had this concern, visit the link below.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

There is no substitute for a personal examination.

However, in cosmetic surgery, less is more.

You need an actual consultation to determine what is the basis for your lower eyelid bag.  It could be herniated orbital fat or it could be exposed orbital rim.  One would be soft (fat) and the other hard (bone).  Fullness caused by exposed orbital rim does not respond to lower eyelid surgery.  You are young with excellent skin tone and should do extremely well with under eye fillers.  The key is not being over done.  You need a lower eyelid.  If you are over filled the result is very unnatural.  Done well, know one will know that you had service and the results can be as good or better than surgery.  The place to start is a personal consultation with a very experiences aesthetic oculofacial surgeon who does both excellent facial fillers and lower eyelid surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.