Saggy / puffy under eye bag causes. What nonsurgical treatments will help? (Photos)

Question

24 years old. This unilateral puffiness and slight dropping has been around for a year now. Had pretty bad dust allergies which I’m now on immunotherapy for. This eye thing has been bugging me - hate that it’s just on one side! I also notice that one eye bag twitches a lot too. How can I ascertain if it’s a fat herniation or asymmetrical ageing or just long term fluid retention ? What treatments could I seek (besides surgery ,given my age)? Please see the images below! Thanks!

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Fat herniation happens when the fat that naturally cushions the eye starts to push forward. This type of puffiness is more structural and permanent, and often creates a bulge that doesn’t go away with lifestyle changes or skincare. If you gently press on the area and the puffiness remains or feels firm and doesn’t shift much, it may be herniated fat. In this case, fillers can sometimes help mask the transition between the under-eye and cheek, especially if there's hollowing beneath the bag. However, lower eyelid surgery (blepharoplasty) is the gold standard if the herniation is significant and bothersome. Fluid retention tends to cause puffiness that fluctuates—worse in the morning, during allergy season, after salty meals, or when sleep is poor. If your under-eye area changes from day to day or improves with lymphatic massage, cold compresses, or elevation, it’s likely fluid-related. For this, lifestyle changes, topical caffeine-based eye creams, or treatments like Morpheus8 or RF microneedling (to firm the skin and reduce fluid trapping) can help. I hope this helps and best of luck!

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns and photos. At 24, it's understandable to seek non-surgical options for addressing under-eye issues. Here are some potential causes and treatments to consider:

Causes:
Allergies: Since you mentioned a history of dust allergies and are currently receiving immunotherapy, allergies can contribute to puffiness and fluid retention. Ensuring your allergies are well-managed is a crucial first step.
Fluid Retention: This can often result from lifestyle factors such as diet (high salt intake), sleep patterns, or even hormonal changes.
Fat Herniation: This occurs when the fat that naturally supports the eyes moves into the lower eyelids, creating a puffy appearance. This can happen asymmetrically.
Muscle Twitching: The twitching could be related to stress, fatigue, or even caffeine intake.

Non-Surgical Treatments:
Topical Treatments: Consider using eye creams with ingredients like caffeine or retinol, which can temporarily reduce puffiness and improve skin texture.
Dermal Fillers: Hyaluronic acid fillers can help even out the under-eye area and reduce the appearance of puffiness by smoothing the transition between the cheek and the under-eye.
Laser Therapy: Treatments like fractional lasers can improve skin texture and promote collagen production, which may help in tightening the skin.
Radiofrequency or Ultrasound Therapy: These treatments can help in tightening the skin and reducing minor fat bulges by stimulating collagen production.
Lifestyle Modifications: Ensure adequate hydration, reduce salt intake, and get sufficient sleep. Cold compresses can also help reduce temporary puffiness.

Consultation:
A consultation with a dermatologist or a cosmetic specialist is recommended to determine the exact cause of your unilateral puffiness. They can perform a physical examination and may suggest imaging if necessary to rule out any underlying conditions.

Addressing these concerns with a professional can help you choose the best treatment tailored to your specific needs.

I hope this helps you explore the non-surgical options available and provides a path forward in managing your under-eye concerns.

Glenn Murray, MBBS · Answer

Non surgical options can include laser or skin tightening via radiofrequency 
So either Jett Plasma or Agnes

Camille Cash, MD · Answer

This can be caused for several reasons including allergies, genetics, lifestyle, etc.  You can consider treatments such as under eye filler and Morpheus8 in addition to addressing the underlying problem.  visit with an expert injector near you to learn more.

Saggy / puffy under eye bag causes. What nonsurgical treatments will help? (Photos)

Answers (4)

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