I'm concerned about my under eye bag and sometimes I have puffiness. What procedure do you recommend?

Doctor Answers 6

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.


New York Facial Plastic Surgeon
4.6 out of 5 stars 87 reviews

Your picture looking up really helps. I would recommend surgery as it doesn't need maintenance, and leaves no scar

Thank you for the question. You submitted 2 photos and ask about under eye bags and puffiness.

I can certainly assist and guide you on how to approach this issue. A little background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. Under eye bags has to be one of the most common issues we address in our practice, and we’ve developed many ways to advance the approach to optimize their recovery. I’ll give you a little understanding as to the actual cause for your puffiness.

You submitted a photo looking straight up, which is very helpful because it allows the forward expression or movement of the eye anatomy called the orbital fat. This shows there are fat pockets that have pushed forward, which are responsible for the puffiness which we refer to as lower eyelid fat prolapse or lower eyelid fat herniation. This means the fat that’s normally part of eye anatomy pushes forward and creates these bulges. When these bulges are prominent and constant, they make you look like you have bags under your eyes. Very often, people may ask you if you are tired, if you’ve gotten enough sleep, or other things associated with under eye bags.

In a situation like yours, the approach that I would typically recommend is a combination. First would be to address the fat pockets through a surgical procedure called a lower eyelid transconjunctival blepharoplasty, meaning I address the fat pockets from the inside of the eyelids to avoid any external incision or scar. What I’m doing essentially is I’m sculpting the fat through reduction and repositioning so there’s no more bulge pushing forward. In addition, I often combine this procedure with the application of platelet-rich plasma (PRP) to help improve the skin tissue quality.  

Platelet-rich plasma (PRP) is a concentration of the healing and growth factors from your blood, which we use to help address some of the changes related to both aging and environmental stressors of the skin around the eyes. We’re addressing more comprehensively the fat pushing forward and the skin quality so you have a more global improvement of this area. It is not unusual when someone has aging changes and environmental or other stressors to the eye area that it takes a combination approach to maximize improvement of the appearance.

Going back to the approach of lower eyelid fat prolapse, I do this procedure under local anesthesia with LITE™ IV sedation. This means you don’t have to undergo general anesthesia. This minimizes the stress to your body as well maximizes your healing potential in a way that people go back to work faster - typically our patients go back to work in less than a week. We do these procedures in our office that has a Joint Commission approved facility, meaning we adhere to standards of safety and personnel comparable to any hospital, so you get the best of both worlds and you are able to recover quicker. Over my 20-year career, this has been an evolution that has optimized the outcomes for our patients.

I recommend you meet with qualified, experienced cosmetic surgeons who offer comparable options. Learn about what you can have done in a way that is optimal for you so you can get the best result aesthetically, safely, and a quick recovery. Once you are comfortable with the doctor, seen their before and after pictures, and you feel you are having a good connection, move forward. I think this will make a very nice difference for you. I hope that was helpful, I wish you the best of luck and thank you for your question.

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 62 reviews

Under eye puffiness

Thank you for your question.  You're concern is a common one among patient's who seek treatment for under eye puffiness, and who often complain of "looking tired".  Based on your pictures, you may be a candidate for a lower eyelid blepharoplasty to remove excess bulging fat.  The procedure may be combined with a dermal filler to address the tear trough to soften the junction between the upper cheek and lower eyelid, and to achieve a natural, youthful appearance.

Paul Nazemi, MD
Newport Beach Oculoplastic Surgeon

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Eyelid

Hello and thank you for your question. Given your concerns your best option would be a blepharoplasty in order to improve the lower eyelids. Hyaluronic acid filler can be used to soften the tear trough region but this is not a permanent solution. I would discuss your concerns with a qualified surgeon. Best WishesTheodore T. Nyame MD  Harvard Trained Plastic Surgeon

Theodore Nyame, MD
Charlotte Physician
5.0 out of 5 stars 28 reviews

Needs evaluation

Hyaluronic acid fillers can help, as can blepharoplasty surgery with fat repositioning into the tear trough.

Eyelid Surgery

Thank you for your question. Eyelid surgery, or blepharoplasty, can address puffy, tired and saggy eyes. With your candidacy for this procedure, please consult with a board certified facial plastic surgeon. Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 96 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.