I’m a cosmetic oculofacial plastic surgeon specializing in this area for almost over 20 years and I can tell you that many people come to me with different variations of a story like yours. Bags under the eyes represent lower eyelid fat prolapse which means that the fat that is normally around the eyes pushes forward. Most of the time, even with a clinical history of sinus issues, allergies, sinus surgery or other factors that can cause facial swelling, there is still often a hereditary factor. When people first notice under eye bags in the absence of a history like yours, they always mention that they have some good days and some not good days. As time goes on, they tend to have puffiness that is always present. Given your current medical situation that’s still evolving, especially with the anemia being a factor, I think that it is reasonable to consider a non-surgical option such as the use of a hyaluronic acid filler. In our practice, for under eye pockets that are very early and minimal, we do perform the application of hyaluronic acid such as Restylane and place it into the tear trough area. This is to soften the transition between the puffy bags and the valley underneath the eyes which make the puffy bags look puffy. Often, some doctors will be a little overzealous and try to fill in the area and then the results look terrible. You should also be mindful that hyaluronic acid fillers can also cause swelling so the approach should be relatively conservative if you are going to try that first. In our practice, we commonly combine hyaluronic acid fillers with platelet-rich plasma (PRP). Platelet-rich plasma is derived from your own blood and it is the concentration of the healing and growth factors necessary for wound healing. It helps improve the skin quality and acts very well in synergy with hyaluronic acid. Again, with the issue of your medical history still influx, I think a conservative measure is probably best explored rather than moving forward directly with surgery. At the same time, it is probably your benefit to not do any kind of intervention and observe whether or not the fat pockets are consistently there for weeks at a time. This will give you a sense of the constant nature of the fat pockets being present. I hope that was helpful, I wish you the best of luck, and thank you for question. This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.