21 year old with horrible under eye bags since my lower teen years. What can be done to help me? (photos)

On a daily basis when I am both with and without makeup I walk into different business' and constantly hear the comment... "Must have been a long night, after getting 8-10 hours of sleep". Its a constant struggle I deal with on a daily basis and nothing would make me happier than to help find a solution to this problem. I have attached some pictures and would appreciate any advice.

Doctor Answers 10

Lower lid bag treatment

Thank you for asking about your lower lid eye bags.

  • Fillers are fashionable right now but will not give you permanent correction and are not what I would use.
  • You have an inherited excess of lower lid fat causing lower lid puffiness.
  • For the puffiness, you need a lower lid blepharoplasty with trimming of the excess fat - this can be done through an inner incision leaving no visible scar and gives permanent improvement - much cheaper than fillers in the long run.
  • For the darkness, you want first to treat the skin with a combination of tretinoin cream and 4% hydroquinone cream
  • Then have a 30% TCA - can be done with the lower lid surgery.
  • If lower lids still dark, discuss a phenol peel of the lower lids with your surgeon.
  • Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

Filler

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.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 87 reviews

Eye Rejuvenation Treatments

There are a wide variety of eye rejuvenation treatments available. For under eye hollowness injectable dermal fillers such as Restylane can be a great non surgical approach. If you have excess fat under your eyes (difficult to tell from the photographs) a surgical option could benefit you as well. I would recommend an in person exam to determine your candidacy.

Dr. Kathleen Morno

Kathleen Morno, MD
Highland Park Physician
5.0 out of 5 stars 1 review

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The eyes are best treated with a combination approach of fillers, lasers, microneedling/PRP for improvement. Ultherapy/thermage, venus legacy all do well for swelling or puffiness. I would suggest consulting an expert. Best, Dr. Emer.

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What can I do for my lower eyelid bags?

Given your age, surgical and non surgical options may be a good fit. See a surgeon very experienced in both.

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Lower eyelid skin pigmentation

Although your photos could be of better quality and magnification, it appears as if you have some bulging that could be due to excess lower lid fat. This can cause shadowing and can be made worse with the slight shallowness that people get in the naojugal groove (shallowness between the eyelid and the nose). I agree that it appears that you might benefit from either fat removal or repositioning.  You also seem to have some hyper pigmentation of the skin.  The result is variable, but you might benefit from some sort of laser skin treatment to try to lighten thing up a bit.

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21 year old with horrible under eye bags since my lower teen years. What can be done to help me?

What I see in the photo provided is dark skin color circles (due to very thin skin) and a hollow depression under the lower lid. In my opinion transconjunctival blepharoplasty with composite fat grafting (harvesting fat from under the pubic hair) may be your best option.

Very few surgeons know how to do this operation so find an occuloplastic surgeon or a plastic surgeon experienced in fat grafting to the eye. DO NOT have fat or filler injections-they will make it worse. Please read below:

Under eye bags with tired appearance

It is not sleep related. See an oculoplastic specialist for evaluation. You will likely benefit from lower blepharoplasty (transconjunctival with fat repositioning). See video and link below.  Filler injection may be another option.

Mehryar (Ray) Taban, MD, FACS
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Darkness and bags of lower eyelids

Thank you for sharing your question. It appears from your photos that lower blepharoplasty with skin resurfacing would help you. After consultation in person, it might look like injection of dermal fillers can treat the problem. See an eyelid specialist for consultation.
Good luck,

Lower eyelid bags

Lower eyelid bags are usually caused by one of three things: excess lower lid skin, muscle, or fat. Lower lid fluid, or edema, can contribute, But that is usually a transient contribution. This becomes especially noticeable when one of the other three traditional issues is happening simultaneously, and that is why you may notice fluctuations throughout the day. It is difficult to tell from the photos you posted exactly what is happening. When the bags are dark, this is often from a genetic predisposition where the muscle in your lower eyelid shows through the traditionally thin skin that sits on top of it.

Your best bet would be to seek out consultation with somebody who regularly treats lower eyelid bags to see what your individual needs and options are.

To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Cameron Chesnut
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Cameron Chesnut, MD, FAAD, FACMS
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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.