Would transconjunctival blepharoplasty correct my dark circles and eye bags? (Photos)

I am 26 years old with chronic, hereditary dark circles and eye bags. I perpetually look tired. What permanent treatment would help me?

Doctor Answers 20

Think Twice About Surgery

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Based on your pictures, surgery is likely not necessary - you have little, if any, bulging fat and no excess skin. The dark lines under you eyes (the circles) are likely a due to the fact that the skin of your tear troughs is thin, with minimal tissue underneath, and the skin in this area is of a darker, oilier quality. 

This is a common, but difficult problem. You would likely see some correction from a thin filler such as Belotero, Restylane Silk, or Volbella to bring up the depths of the trough and improve the contour in the area. Unfortunately, this may not improve the skin quality and, thus, some residual discoloration may remain.

See the link below for more information on fillers.

A detailed examination will help delineate the best option. Consultation with a surgeon certified by the American Board of Plastic Surgery would be the next best step.

Eyelid treatment...

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There is definitely a genetic component to eye bags. I have worked on many people in their twenties that have the same thing and a transconjunctival blepharoplasty is a nice start. It should be combined with fat injection into the crease underneath the eye bag. That way a nice smooth appearance will result.

Andrew Miller, MD
Edison Facial Plastic Surgeon
4.8 out of 5 stars 222 reviews

Would transconjunctival blepharoplasty correct my dark circles and eye bags?

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Yes, transconjunctival lower blepharoplasty with fat bags repositioning can correct or at least reduce the under eye bags and dark circles. See following video and link.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Transconjunctival Blepharoplasty?

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Hi and thanks for the question and photos.  You area very good candidate for a lower lid transconjunctival blepharoplasty.  I disagree with some of the other docs who have answered your question about the dark circles.  A significant degree of the darkness is due to the shadow that is caused by the fat pads that are protruding and causing light from above to be blocked.  You can prove this to your self by tightening the lower lid with your index finger which will make the bag go away and you will see much of the dark circle go away.  Good luck.  

Jonathan Pontell, MD, FACS
Philadelphia Facial Plastic Surgeon
4.8 out of 5 stars 113 reviews

Treating eye bags, circles and lines

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There are many causes of eye bags. Some are shadow issues, some are discoloration issues. 

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty (transconjunctival and transcuteous through the skin are options) with fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Dark Circles: Surgery or Filler?

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From the photos submitted, it appears that you have some lower eyelid puffiness AND hollowing of the upper cheek or tear trough. Most patients with both issues need surgery and fat repositioning or fat grafting. However, some patients will do very well with just under eye filler. In cases like yours, where the puffiness and the hollowing are not extreme, it is hard to say which one is best. I generally recommend the non-surgical treatments first. If insufficient, then surgery is the next step.

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 55 reviews

Would transconjunctival blepharoplasty correct my dark circles and eye bags?

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A transconjunctival lower blepharoplasty can help remove the eye bags with the incision placed on the inside of the eyelids. In addition, the shadow effect is also removed since the puffiness is gone. Dark discoloration of the skin will not be improved. For more information  and many before-and-after eyelid surgery examples, please see the link and the video below. 

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

No, it is not going to correct your issues.

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There are many anatomic issues that makes circles and "bags."  Not all of them are caused by herniate orbital fat.  However, if you are a hammer, all the world looks like a nail.  If all you do is lower eyelid surgery, you want to fix everything that way.  Put your finger on the bump.  What you are feeling is your orbital rim.  Transconjunctival lower eyelid surgery is not fixing that.  What you need is a very experienced injector to fill the hollow with hyaluronic acid filler.  This is a fussy service but it is likely to last over a year for you.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Dark Circles/Bags under eyes

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I agree with some of the other recommendations in that a lower lid transconjunctival bleph can reduce the volume of fat and give a smoother look. In addition, filler is an option (juvederm/restylane, etc.)

However, I would also consider PRP injection to the lower lid to help with the overall appearance of the lower lid (hollowing, coloration, etc.). This is an easy procedure done in-office with minimal to no downtime.

See the link below for some information when used with microneedling. 

All the best,

Eyelid bags and dark circles

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Thank you for question.  Based upon your photo you appear to be a good candidate for a lower eyelid transconjunctival (scarless) blepharoplasty.  While this might provide a nice long term result there are other less invasive options.  I would also consider lower eyelid tear trough injections with Restylane.  This would be less invasive and could last up to a year.  Dark circles under the eyes tend to come from a shadow effect where a bag (fat) casts a shadow in the depressed valley below.  There could also be pigmentation problems or thin skin visualizing the underlying structures.  I wouldn't recommend a proper in person evaluation with an Oculoplastic surgeon.

Thank you

Dr.Rob Schwarcz 

Robert Schwarcz, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 23 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.