Under eye bags? Fluid retention? What is it? (photos)

Question

I was born with them. They're not that prominent but they get to be under harsh lighting. I tried getting enough sleep but they never seemed to go away or even reduce in size. I tried massages to but they didn't seem to work. At times they make me appear tired. They're not that dark but they still stick out of my face a quite a bit. What are these? Is it fat? Fluid? And what can I do about it?

Larry S. Nichter, MD, MS, FACS · Answer

You are probably a great candidate for a blepharoplasty, eyelid lift procedure. Of all the features on our faces, our eyes are the most prominent indicators of our mood, energy level, and youth. Sagging, drooping, or tired-looking eyes can make us look older than we really feel. Eyelid surgery, or blepharoplasty, is a plastic surgical procedure designed to improve the message our eyes send to those around us.Who is a candidate?Patients who would benefit from a blepharoplasty include those who experience:
Excessive, sagging, or wrinkled upper or lower eyelid skin.Excess upper eyelid skin that interferes with vision.Loss of your natural upper eyelid creaseIf you have puffy pouches of fat in the upper or lower lids that create a tired or aged appearance.Orbital Rim Show: visibility of the bone under the eye sometimes contributing to a dark ring or shadowing.Normally, everyone has a small amount of fat around the eyes. If the quantity of fat increases or the local tissues stretch and weaken, the fat begins to bulge producing “bags.” Occasionally this bulging is seen in young patients and is an inherited family trait, and not a result of aging. These changes have a profound effect on one’s appearance giving a tired or haggard appearance. An attractive face with these early signs of aging can affect a patient’s self-image, attitude and sense of well-being.Intended ResultA blepharoplasty is a procedure designed to improve the appearance of the eyelid area. This may involve removing excess skin and if needed tightening the surrounding muscle resulting in a more youthful, refreshed appearance. This procedure can treat both the upper and lower eyelids depending on the unique needs of the patient.

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.

M. Dean Vistnes, MD · Answer

You look very young from the photo to have or need any surgery and the photo is not ideal to evaluate things but something more conservative like a filler may be far more appropriate. See a board certified  surgeon in your area with an expertise in aesthetic surgery for more information. Good luck!

Julian W. Dixon, MD · Answer

Hi thanks for your question. This area is a common concern for many people. Fortunately there are good options. HA fillers are an excellent way to smooth the transition between the lower lid and cheek, which is exactly where your area of concern is. There are many surgical options to improve this area as well, but that may not be necessary. The only way to really tell which procedures would be best for you would be an in person consultation. But the good news is there are plenty of options that can improve this area for you. Hope this helps.

Under eye bags? Fluid retention? What is it? (photos)

Answers (4)

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