What can be done to my undereye area to get rid of my bags, HA injections, fat transfer, surgery? (photos)

My question is what do you think is the best way to get rid of my undereye's bags? I am a 22 years old woman with clear skin and bags... I am not sure if HA fillers would be the best option in my case since my undereye doesn't crease that much but are kinda puffy instead? They are kinda blue-ish too. Also, I received lips fillers a couple times and I got very swollen from Juvederm, and still weeks after I was sometimes waking up with swollen lips. (But I was fine with Revanesse and Emervel)

Doctor Answers 9

Lower eyelid bags

Looking at your photos I would suggest a lower eyelid, trans-conjunctival blepharopalsty.  In my experience, this is an excellent procedure for young women with bags of the lower lids.  It has a quick recovery and there will be no incisions on the skin, so no scars.  Good luck


New York Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Lower eyelid solutions

Hello and thank you for posting your question and photographs on RealSelf!
Much of what the other surgeons have suggested is reasonable for your particular issue. Making sure all allergies and external causes of swelling (alcohol intake, etc) are addressed prior to any interventions you elect is paramount. After this has been accounted for, you may very well benefit from transconjunctival fat excision and midface fat grafting in addition to laser resurfacing (like Fraxel )of the lower eyelid skin to improve your tear trough problem. 
Best of luck in reaching your goals!

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

Fillers or eyelid surgery + fat transfer can give you beautiful results

Hello!

Under-eye bags are caused by a combination of 2 problems: one, fat behind the eyelid protrudes forward, and two, often there's not enough cheek fat below it. This creates a break in the contour from your eyelid to your cheek which becomes visible as a shadow.  

At 22, your under-eye bags are hereditary rather than age-related (does mom have this, too?), and you have more options than a middle aged person with the same issue. Filler is a good non-surgical option to add volume to your upper cheek and tear trough (the indentation below the under-eye bag). This masks the bag by creating a smooth transition from the lower eyelid to the upper cheek. The disadvantages are that fillers are temporary and may not give full correction.

A permanent result through surgery would involve a scarless incision on the inside of the lower eyelids through which the protruding fat is plucked out - this removes the extra volume. I'd also recommend adding volume to your cheeks and tear troughs at the same time with fat transfer. In this technique I borrow some fat from your abdomen through liposuction and then carefully inject it into the cheeks and tear troughs. Again, the goal is to remove volume where it's not needed (eyelids) and add volume where it is (cheeks), and thus create a smooth transition from eyelid to cheek so that the shadow between them disappears. 

All in all you have excellent options from which, in skilled hands, you can get an excellent result. 

All the best in your search!
- Dr. Rad

Ariel N. Rad, MD, PhD
Washington DC Plastic Surgeon
5.0 out of 5 stars 48 reviews

TRANS-CONJUNCTIVAL BLEPHAROPLASTY

Young patients with herniated fat and no significant excess skin may be candidates for a trans-conjunctival no scar technique. (see video).  A detailed examination would be required to see if you are a candidate.

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.8 out of 5 stars 9 reviews

What can be done to my undereye area to get rid of my bags, HA injections, fat transfer, surgery?

The best recommendation typically come after an in-office examination.  More than likely the best results and long term improvement comes after lower blepharoplasty using the fat repositioning technique.  Fillers have a limited role in the lower eyelid area with many patients not very good candidates for the procedure.  Fat transfer is an excellent treatment choice and can be combined with blepharoplasty to provide superior results.

The attached link provides more information.

I hope this helps.

Timothy R. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

You need a personal consultation to determine what is best here.

However, let me recommend that you do your own examination here.  Put your finger on top of your "bag."  If this is firm, what you are feeling is your bony orbital rim.  That is not fixed with lower eyelid surgery.  If that is the case, properly performed hyaluronic acid filler would be your best option at age 22 and likely to work for over a year with each service.  It is a great option.  Here is the challenge.  I am based in Beverly Hills and yet I see people from all over the world for under eye fillers.  That means these folks could not find a good injector for this treatment in London, Paris, Dubai, etc.  That means that finding the right injector in your town for this service can be a tall order.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Treatment for lower eyelid bags

Thank you for sharing your question. It appears from your photos that lower blepharoplasty would be the best option for you, but in person, it might look possible to use fillers to hide the bags. Comprehensive evaluation by an experienced, board-certified Oculoplatic Surgeon will help guide you in the right direction.
Good luck,

Filler or surgery for under eye bags

Many patients have fatty deposits under the eyes and they can be camouflaged with the use of fillers to soften the valleys.  By filling up the deep groves (valleys) the hills do not look as tall, thus making the areas look better.  Another option would be to remove or redistribute the fatty deposits surgically.  This is a procedure called Blepharoplasty.  If you have had trouble with HA products, you may consider surgical blepharoplasty to help this.  There is an amazing plastic surgeon in Montreal (close to Mirabel) named Dr. Swift that you may consider meeting in consultation who may assist you with making a decision.
Good luck

Samuel Shatkin, Jr., MD
Buffalo Plastic Surgeon
4.8 out of 5 stars 15 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.