Reason why I suddenly got under eye bags...what type of treatment should I look for?

Thank you for your question. I understand you’re 30-years-old and concerned about the sudden appearance of under eye bags. You state you’ve been trying to live a healthier lifestyle — taking vitamin supplements, quitting smoking, staying hydrated, and losing weight — though none of these helped improve the appearance of your eye bags. You also state your mother also has eye bags, which she didn’t get until she was 50-years-old.

I understand your frustration with your eye bags, and it’s definitely a very common issue that affects many people of all ages and ethnicities. To first give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. Eye bag surgery is easily one of the more popular procedures I perform in my practice, so I can certainly help you with your concern.

More often than not, there is a family or genetic component in the manifestation of eye bags. In fact, I have operated on three generations within the same family for eye bags. Eye bags do tend to have an aging effect on the face, but the remarkable thing about them is once you address them, it is literally like getting a facelift - suddenly, one’s appearance looks more youthful and less tired.

Under eye bags are caused by lower eyelid fat prolapse, and come about when the fat pockets around the eyes become displaced and push forward. It is important to understand that environmental stressors can play a role in accelerating the progression of eye bags, just as genetics do. For example, you say your mother developed eye bags at the age of 50, but just because she had a later onset doesn’t mean that it couldn’t have happened at an earlier time.

Nowadays, there are a number of different ways to address eye bags, and I think this leaves many people more confused than ever. When I first started my practice 20 years ago, before the advent of many of the non-surgical treatments we have today, eye creams were usually the first method employed against eye bags. When the eye creams failed, which they always did, then people would opt for surgery.

Today there are more options and newer technologies available. In our practice, we address slight under eye bags with the help of hyaluronic acid filler like Restylane, and platelet-rich plasma. This combination, when placed in the area, softens the transition between the under eye bag and the surrounding skin; while the platelet-rich plasma, which is derived from your own blood, improves overall skin quality. In the case of slight under eye bags, the under eye skin usually just needs a little toning up, and the combination of platelet-rich plasma and Restylane accomplishes this very well.

Keep in mind that this method and other non-surgical methods involving radiofrequency devices, only works on slight under eye bags, and not on very prominent eye bags. Injecting filler in an attempt to camouflage prominent eye bags will only cause them to look bigger and puffier, and in some instances can also cause lumps and irregularities. Radiofrequency devices can also cause a certain amount of skin tightening which may benefit slight under eye bags, but there are still limitations to this. Many people make the mistake of being overly aggressive with radiofrequency devices in the hope of tightening the skin enough to reduce the appearance of eye bags, but this only leads to skin damage and volume loss.

That said, to address a case such as yours, I usually perform a procedure called a transconjunctival blepharoplasty. This procedure allows me to approach the fat pockets from the inside of the eyelid to reduce, reposition, and sculpt the fat directly. After the procedure, I usually apply platelet-rich plasma to improve overall skin quality, and depending on your skin type, I would also make use of either fractional CO2 laser, erbium laser, radiofrequency technology, or a non-surgical skin tightening treatment such as Pelleve.

The beauty about a transconjunctival blepharoplasty is it deals with under eye bags definitively, and the results last for a very long time, especially in younger people. Even patients who I performed eyelid surgery on 15-20 years ago will come and see me saying that they feel like they still look great, and that it’s time for me to do injectables or a facelift. There certainly is value in the longevity of the procedure.

Ultimately, I think you’re on the right track in terms of the steps you’re taking to improve your health and the research you’ve done. I advise you meet with qualified and experienced cosmetic surgeons or specialists and learn more about the options I discussed, as well as the type of anesthesia used.

I know many people are hesitant to undergo surgery because they’re afraid of general anesthesia and hospitalization, which is also why they opt for non-invasive procedures. In our practice, we perform all our procedures under local anesthesia with LITE™ sedation, which means that the patient is never completely knocked out, but placed in a calm twilight state of consciousness. Our facilities are approved by the Joint Commission and we combine the facilities of a dermatology office and hospital with the true formality of a skin surgical suite - it really is the best of both worlds. We ensure that our patients recover quickly, they are comfortable, and are well taken care of post-surgery. We’ve been very successful with this type of process and the benefits have been very nice for both doctor and patient.

I hope that was helpful and I wish you the best of luck!

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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.

I suggest you see an expert for treatment this is easily treated with lasers, microneedling, fillers and skin care.  Best, Dr. Emer.