Am I too young to have my under eye bags fixed? Is surgery or injections better? (photos)

Question

I'm 25 years old and I have had baggy dark circles for my entire life. People are always asking me if I'm tired or upset and it drives me crazy. They only seem to "go away" in certain lighting. I am constantly aware of my sad looking eyes and I don't won't to be self conscious the rest of my life

Douglas Wu, MD · Answer

I’m sorry to hear of your troubles.  Non-surgical options for under eye bags are usually the preferred treatment modality especially in someone as young as yourself.  That being said, Under eye bags and dark circles are certainly a tricky area to treat.  It is important to identify the cause before selecting a treatment plan.  The causes of under eye bags and dark circles are usually multiple and include volume loss, increased pigmentation, increased vascularity, and fine lines and wrinkling.  The options available to target these factors include fillers such as Restylane or Belotero, lasers for pigment and vasculature, and resurfacing, ultrasound, or radiofrequency for fine lines and wrinkling.  Combination treatments will typically achieve the best results but they must be applied in skillful and experienced hands.  In your particular situation, trying to even out naturally occurring imbalances takes a delicate touch.  Please consults with a Board Certified cosmetic dermatologist with experience in these types of treatments.  Hope that helps and best of luck!

Sheila S. Nazarian, MD · Answer

Always best, I think, to start with the least invasive approach. Especially in someone as young as yourself. I like to use a bit of HA filler such as Restylane in the tear trough area to eliminate bags. Schedule a consultation with a board certified plastic surgeon in your area to discuss. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Elliot M. Heller, MD · Answer

You may want to talk to a doctor to see if fillers may work for you. Maybe talk to them about Belotero, or what other fillers they recommend. this is something that you do not need surgery for unless it is necessary. Lower Blephs. The price for surgery starts at $3,500.

Trevor M. Born, MD · Answer

Dear Mymic23Thank you for your question and photo!The lower eyelid for you would be best treated with surgery for a long lasting result. A combination of removing the puffy fat and addition of volume under the eye with micro fat grafting would give a nice change without the appearance of having had surgery.With Warm RegardsTrevor M Born MD

Jason Emer, MD · Answer

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

Tanveer Janjua, MD · Answer

The lower eyelid back to definitely there and is photographed and the best solution would be a blepharoplasty to reduce the fat bulge.  He would also benefit from strict sun protection and either laser treatment or glycolic acid peel to reduce the darkness in the lower eyelid skin.  Your not too young to do the surgery.RegardsDr. JDark
Circles under the eyes (by Tanveer A. Janjua, MD)

The
dark circles happen from many different reasons. It usually is a contrast
between the surrounding pale skin and darker skin of the lower eyelids. The sun
shines down from above exposing more of the lower eyelid skin that sits on a
platform of the cheeks. This is why the football players put dark grease under
the eyes to reduce the glare effect. When you are born skin color is the same
for all of the facial skin. After years of sun exposure it starts appearing
darker than the surrounding skin. There are a few more contributing factors.
Allergies can increase blood supply leading to dark blood causing congestion
and dark shiners. Excess fat of the lower eyelid skin can cause a shadow effect
and make the dark circles look worst. 
In light of the above the treatment depends on the cause. For sun induced
darkness lasers and chemical peels help. However, exposure to sun can bring it
back. Strict daily application of sun screen and wearing sunglasses is a
must. 
If you have allergies, then proper use of antihistamines, and nasal steroid
sprays under the supervision of a physician or immunotherapy will help. 
Lastly if there is fat bulging from the lower eyelids then there are two good
options. In cases of small amount of fat, injecting a filler such as Juvederm or
Restylane just below the fat bulge in the tear trough will camouflage the bags
and hence reduce the dark circles. If there is a lot of fat then lower eyelid
blepharoplasty is a viable solution. In this procedure excess fat is excised
along with a small amount of excess skin and then lower eyelid becomes
relatively flat reducing any appearance of dark circles.

Paul J. Leahy, MD · Answer

Thank you for your question, and I understand your concern about your lower lids. I do think you are too young to require surgery. I think you could get some very nice improvement using soft tissue fillers such as Juvederm, or even fat grafting. I would definitely visit with a local plastic surgeon. Best of luck.

Heidi A. Waldorf, MD · Answer

From the photo, it appears that your dark undereye shadows are created not by pigmentation but by the lack of volume in that area.  When we are missing deep fat in the central cheek, the lack of transition between the more superficial fat under the eyes and the superficial fat of the cheek creates a 'tear trough' or hollow.  It can develop over time as fat is lost over time or can be related to your underlying facial structure.  Either way, it can be treated with careful injection of a hyaluronic acid filler like restylane or belotero.  It is important that your physician evaluate your full face rather than just focusing on that central area because too much filler in the tear trough can look puffy and un-natural.  I tend to start my injections closer to the side cheekbone area which lifts the adjacent central skin and then allows me to use less centrally.  And starting now means you will need less filler, less often than if you wait until you also have age related volume loss.  I hope this answer has been helpful.  Wishing you the best of luck!

Robert Singer, MD · Answer

There are numerous reasons for dark circles including: Lack
of fat in the hollow area called the tear trough, small blood vessels under the
skin, congenital pigment in the skin, and shadowing from a combination of hills
(fat pads) and depressions (tear troughs). Most expert experienced artistic
plastic surgeons have a variety of procedures, both non-surgical and surgical,
at their disposal to produce excellent cosmetic results in the appropriately
selected patient: Botox or Dysport, temporary hyaluronic acid fillers like
Restylane, long-lasting micro-fat grafts, light peels, lasers,
blepharoplasties, or combinations of procedures. Each has benefits and
drawbacks and depends on desired outcome and individual anatomy.

A temporary filler like Restylane would be a reasonable initial treatment. It can improve the cosmetic
appearance of the eyes. However, In a patient with your inherited anatomy, a blepharoplasty to contour the bulging fat and micro-fat
grafts to fill the depressed tear trough will produce the best and longest
lasting cosmetic result. The dark circles will be less obvious, but not totally
eliminated

Following the advice of anyone who would presume to tell you
what to do without seeing photos and without taking a full medical history,
examining you, feeling and assessing your tissue tone, discussing your desired
outcome and fully informing you about the pros and cons of each option would
not be in your best interest. Find a plastic surgeon that you are comfortable
with and one that you trust and listen to his or her advice. The surgeon should
be certified by the American Board of Plastic Surgery and ideally a member of
the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss
your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla,
 California

Andrew Kornstein, MD, FACS · Answer

In the majority of cases, the indication for surgery has to do more with anatomy than age per se.You have a genetically shallow orbit(eye socket) and therefore early protrusion of orbital(socket) fat via the lower eyelid. Both the upper and lower eyelid are showing signs of this stress as the skin over both lids are hyperpigmented. In general, these issues tend to worsen with age. In addition to transconjuctival lower lid fat removal(inside incision), I prefer fat grafting because of it's relatively low cost relative to fillers over the years, it's longevity and the vascular growth factors that reduce further bone aging in this region. Long terms survival and aesthetics are very dependent on experience and three dimensional artistic technique.Hope this helps

Am I too young to have my under eye bags fixed? Is surgery or injections better? (photos)

Answers (10)

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