50 y/o female with prominent under eye bags - what could be causing this and what can be done to minimize it? (photos)

The lower bulge on the right side is not consistent with lower eyelid fat prolapse and is most likely swelling. This is often called malar bags/festoons and most likely is associated with filler injections as hyaluronic acid based fillers are hydrophilic, ie they attract water.
First plan of actions should be to try to dissolve the filler with hyaluronidase enzyme, if there has EVER been any filler placed in eyelids or cheeks. If you have NEVER had any fillers in your face, then you could consider Morpheus microneedling coupled with Accutite RF treatments.

Thank you for your inquiry! We would love to sit down with you to discuss your concerns. Blepharoplasty removes fat pads and excess skin. Schedule a consultation with a Board Certified Plastic Surgeon to help you reach your goals.

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

You would be a candidate for lower lid blepharoplasty with fat transposition or fat grafting. The herniated lower lid fat is very hydrophilic (likes to absorb water) which means the puffiness can fluctuate. Best to see an eyelid expert.

Thank you for sharing your concerns and posting your photos. Lower eyelid bags come from aging and can be genetically related. Unfortunately, they can suddenly become worse for no apparent reason. Seek consultation with an experienced oculoplastic surgeon for comprehensive examination and discussion of treatment options.
Good luck,

Hello, From the photos you’ve provided it appears you have excess skin and fat of your lower eyelids which causes the appearance of “eye bags”. This can happen for various reasons including the natural aging process. However, this area can be improved with transconjunctival lower blepharoplasty and skin pinch. This procedure will remove the excess fat that is protruding through and causing the appearance of “eye bags”. A full medical history and examination would be needed to determine if you are a candidate for this procedure. Here at Beaches Facial Plastic & Nasal Surgery Center we only work from the neck up. 

It is very likely that small cheek bones are contributing to this problem on top of prolapse (bulging) of fat pads around eyes. Transconjuctival lower blepharoplasty with periorbital fat grafting or small cheek implants should be a procedure to consider.

The photos provided show very signficant volume deficit in the upper cheeks. And, since the upper cheeks are a major physical support to the under-eye region, lack of volume in that region typically gives rise to the bags, tear troughs and hollows. In the hands of an experienced, board certified cosmetic dermatologist filler expert, the use of an HA volumizing filler, properly injected in the upper cheeks would like yield an immediate, significant improvement in the appearance of the entire region--under-eyes & cheeks. Surgical procedures, on the other hand, do NOT address the issue of volume depletion and thereby would not be expected to do much for the problems seen in the photos. You would be wise to consult with an appropriate filler expert. Hope this helps and best of luck.

Looks like you have weakening of the septum and herniation of the fat. You need lower blepharoplasty to address this.

The prominent eye bags are related to genetic fat deposits. They are herniating outward and downwards causing puffiness. A trans-conjunctival approach, lower blepharoplasty and accomplish removal of these fat bags through an incision on the inside of the lower lids.