I have these weird indent bags under my eyes that won’t seem to go away. What do you suggest? (Photo)

Good morning,
I get this question a lot, and hopefully this information will be helpful for you. Under eye bags can become apparent as we get older because our anatomy continue to change as we age. The relative position of fat, skin, bones, cheeks, and ligaments all play a role in the appearance of under eye bags, and each person has a unique combination of these elements.
There are both surgical and non surgical options to address under eye bags, but all interventions carry risks and these must be balanced with the possible benefits of the intervention. In general, non-surgical options include filler injections or fat transfer. These options work by helping to add volume to certain areas to help blend the transition between the lower eyelid and cheek. While these options have the benefit of being less invasive, they care risks including lumps/bumps, discoloration (blueish hue to the eyelid), and inflammation. They also may need to be repeated every few years for lasting results.
A surgical option for lower eyelid bags is a lower eyelid blepharoplasty. Specifically, a transconjunctival approach, which is from inside the eyelid and is scarless. With this approach, fat can be subtracted or translocated to help address any hollows or excesses in fat.
As always, an in person consultation would be best to address your individual concerns.
I hope this helps.

The 1 posted photo demonstrates minor tear trough deformity. Best improved by HA filler injections. Expect fees from $800-$1,800. Best to virtual consult with....

From an aesthetic perspective that part of the face is a bit complex, and not always easy to understand. A lot of basic facial aesthetics, especially in young people is primarily based on bone structure even though it often seems like soft tissues are the problem. In reality what happens is the skeletal foundation allows the soft tissue coverage to drape certain ways that some people may find appealing or less appealing. In an ideal, youthful face, the lower eyelid and the area below should be snug and tight with lots of immediate fullness just below that in the upper part of the cheek or midface. with premature facial aging we get a reverse of those contours. The lower eyelid shows bulging from fat pads around the eye that begin to protrude with loss of volume immediately below. When making an assessment, it’s important to differentiate if the problem is bulging fat pads in the lower eyelids or a loss of volume just below this in the midface, the tear trough deformity. Often it’s a combination of both. If the primary problem is bulging a fat pads in the lower eyelids, then plastic surgeons, sometimes remove some of that fat to improve the contour. If there’s a volume deficit in the upper midface then we sometimes restore volume in that area to improve facial aesthetics. Because the two areas are immediately adjacent upon each other it’s important to differentiate what the problem is and recognize that treatments need to be quite precise, in order not to worsen the problem immediately adjacent.
Because they are relatively complex, you may find different providers offering you different solutions. Midface, volume restoration can be done with implants, fillers, mid facelift, or grafting fat. All of these procedures have advantages and disadvantages.
Considering your age, my best suggestion is to not jump into any surgical procedures, or even treatments for that matter. Instead begin to get educated, facial aesthetics, understanding the area, and what all the various treatments can, or cannot accomplish. When the time is right in the future if this bothers you enough, then you can consider having some form of intervention. For now I think you’re doing fine, you have an attractive face and you should probably avoid premature surgery or treatment.
Do you recognize different providers with good intentions may have different recommendations on the best way of treating this. Some of that may depend on what type of provider you’re communicating with, including what skills they have, or don’t have in their toolbox. A Nurse injector may have a very different approach than inocula plastic surgeon.
Best,
Mats Hagstrom, MD