Hereditary eyebags treatment - but afraid of hollowness and ruining natural smile (photos)

I am 20 years old and have slightly puffy eyebags. They make me look tired and unhappy when my face is relaxed. What is a good treatment with good results down the road as my face ages? Been considering trans bleph, fat transfer, or fillers (but I don't like the fact that fillers are not permanent and I have to keep going back). I am also concerned whether I have a tear trough issue. Also I would like to somehow maintain the crease or fat directly under my eye from my natural smile. What is best for me?

Doctor Answers 7

Under eye bags removal without making it hollow

The best treatment for under eye bags with transconjunctival lower blepharoplasty with fat repositioning. It gets of the rid the bags while NOT making the area hollow. See link below.


Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 62 reviews

Eye bags

At your age I would try some HA fillers such as Restylane.  This will help to smooth out the transition from cheek to lid and mask the fat.  It should last at least 1 - 1.5 years.  
At some point you can consider a surgery.  I prefer to move the fat down into the tear trough with a fat repositioning.  If you take out the fat you may need fillers down the road, so I do not remove it. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

A transconjunctival blepharoplasty would help your eye bags and maintain a natural look, with fat transferring not needed

Thank you for your question. You state you’re 20-years-old, and after reviewing your question, I understand you’re concerned about under eye bags, the potential of tear trough hollowing, as well as the appearance of your face as you age. You are considering a transconjunctival blepharoplasty, fat transfer, and fillers to address your under eye area, but you don’t like the idea of maintenance for fillers.

I can certainly help you with these issues as we routinely treat patients with the same concerns you have. To give you a little of information about myself — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years.
What you seem to have is lower eyelid fat prolapse, which you may have come across during your research. Lower eyelid fat prolapse means the fat normally around your eye has become displaced and is pushing forward, creating a bulge or what we refer to as an eye bag. So how should this be resolved? Do you remove the fat or do you transpose the fat?

In our practice, even with the factoring in of aging, I perform a combination approach for a majority of our patients with the same issues as yours. I reduce and sculpt the displaced fat in the lower eyelid by means of a procedure called a transconjunctival blepharoplasty. With this procedure, the incision is made on the inside of the eyelid and the rest of the procedure is completed through this incision. The beauty about this procedure is that it leaves no external trace of scarring on the skin.

There are certainly other ways to transpose fat and move it to places where there is hollowing, but I don’t think this is necessary at your age. I have performed this type of procedure for women in their 70s for whom it is more appropriate, and though I understand you’re anticipating what could possibly happen as your face ages, I don’t think you should be worried that you are going to look unnatural as you get older, especially since this is an anatomic issue where the fat is simply displaced.

I also agree with your hesitance to use fillers, not because of the issue of maintenance, but because the protrusion of your fat pockets is too pronounced. In our practice, we are able to address mild or slight lower eyelid fat prolapse with the help of Restylane, and improve skin quality with platelet-rich plasma. This type of approach would not be suitable for you because once the protrusion of the fat pockets becomes too significant, using filler would only add to the puffiness.

I have performed this procedure on patients as young as 14-years-old, due to issues relating to genetics, not aging. Many of the older patients that I treat who are in their 20s, 30s, and 40s often say that they’ve had their eye bags since they were born or since they were teenagers. Ultimately, this is an important decision that you need to make, and if you feel conflicted and uncertain on how to go about it, then I suggest you wait until you’re comfortable. Meet with qualified and experienced cosmetic surgeons or specialists who perform both surgical and non-surgical procedures, so you have a wider range of options to learn about. Learn about the risks and benefits of each option, but also keep in mind there is no ideal procedure. I think what you also need to grasp is the idea that, after surgery, the appearance of your eyes without the fat pockets should look as if you never had the fat pockets to begin with.

From my own experience of performing eyelid surgery for 20 years, I would say that a transconjunctival blepharoplasty really makes a world of difference in terms of helping people look their best. Often times, performing this procedure alone makes such an improvement to the overall facial appearance — it is practically like doing a facelift. People tend to look more youthful and less tired. In fact, I always hear patients say that if they knew the procedure was this easy, they would’ve done it sooner. I hope that was helpful and I wish you the best of luck!

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

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Fillers

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

Eye bags dont always require surgery

Often undereye bags are visible not because they are protruding but because the fat pads below - in the deep cheek area - are recessed.  I recommend you see a dermatologist in your area who is not only an experienced injector but who has experience injecting Asians.  The Asian face tends to be flatter centrally so it is important to lift subtly without making the face broader and flatter or too centrally puffy.

I hope that answer was helpful.  Best of luck.

Heidi A. Waldorf, MD
New York Dermatologist
5.0 out of 5 stars 9 reviews

Puffy eyes

Thank you for posting your pictures. The transition point between your eyelid and your cheek can be smooth out with fillers. I like Belotero in this area because it does not attract as much water. When you smile the pretarsal orbicularis might seem a bit hypetrophic, sometimes a touch of botox will work great for this. I would combine both procedures. Later on, if you want a permanent result, then you can have a blepharoplasty with fat transposition to smooth out the transition point, and also prevent hollowness. Good luck. Hope this was helpful.

Bags under eyes

I would recommend transconjunctival lower blepharoplasty to remove excess fat. You may have some mild hollowing afterward which can be treated with filler injections. Under eye fillers often last several years. In my experience this technique produces better, more natural results than fat transfer or fat repositioning.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 147 reviews

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