Is There a Way to Get Rid of Eye Bags Permanently?

Question

I'm 30 years old and have had lower eye bags for as long as I can remember. The bags are present all the time even when I smile/squint. In the mornings when I wake up they look just horrible. But like I said I always have them.I've had Restylane injections before, but they didn't last long and alleviated this condition a little bit. Please help me and tell me what to do. I'm really sick and tired of them. Thank you!

Charles K. Lee, MD, FACS · Answer

Lower lid eye bags are a common issue and there are many ways now to address this.  You have already tried a nonsurgical route with a filler, but this is a very short term fix and not a recommended long term solution.  Very often, I see patients who have had multiple filler injections in the lower lid, only see the problem even more exaggerated and more difficult to fix.The best way to treat lower eyelid bags for the long term is to either have fat removed, repositioned, with +- skin redraping.  There are multiple approaches that be performed and it is best to have a full evaluation with a board certified plastic surgeon with eyelid expertise.

Benjamin Caughlin, MD, FACS · Answer

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  It is good that you feel the Restylane made a difference. You should read and research fat transfer a bit. There are some really good aspects of fat trasnfer. We do a ton of it at our practice. Most people with this problem have a multifactorial issue meaning they have more than one problem causing this demarcation.Below is a list of common causes and my treatment protocol.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about non-surgical treatment of under-eye bags.
There are many ways to tackle under-eye puffiness, lines, and/or dark circles.  There are some skin care products you can use.  Some laser treatments such as ErYag lasers can tighten skin under the eyes and help reduce fine lines.  Platelet Rich Plasma (PRP) microneedling can also tighten the skin and help promote collagen production.  Finally, you can camouflage under eye bags by placing fillers such as Juvederm Vollure or Voluma, or Restylane Defyne in the area.

To be sure, see two or more experienced, licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Mike Majmundar, MD · Answer

Dear Shadi,

	Lower eyelid bags that occur in younger individuals such as yourself is almost always genetic though infrequently fat protrusion as a result of weakening of the orbital septum (the structure that holds the fat back around the eye) can also occur. The fat around the eye has nothing to do with weight gain or weight loss.

	The fact that Restylane helped you temporarily suggests that a permanent correction is possible. Tightening the skin with lasers, peels, or other forms of energy doesn't help the eyelid bags. Your options include either "masking" the bags by injecting a thin material such as Restylane around the puffiness and doing this on a semi-annual basis or smoothing the eyelid to cheek transition by removing or transposing the fat. In my practice, younger patients undergo a transconjunctival lower eyelid blepharoplasty with fat transposition. This entails making an incision behind the eyelid (no external scar) followed by mobilizing the fat and then 'moving' or transposing it to the hollow area below the puffiness allowing a smooth lid to cheek transition.

	Patients are very happy with this 45 minute to 1 hour procedure that can be done under local anesthesia though I feel most individuals do best during the procedure with a mild amount of sedation to keep them comfortable.

Camille Cash, MD · Answer

If you are wanting a permanent solution you may be a candidate for lower blepharoplasty.  In this surgery excess fat and skin is removed.  Remaining fat is redraped revealing a smoother under eye appearance.  I've attached a video that may be helpful.  Visit with a board certified plastic surgeon near you to learn more.

Eric Shreder, DO, MS · Answer

Hi Shadi, thanks for your question. In my experience, Bellafill has produced the most consistent lasting and natural looking results with no down time. Using a thin microcanula, I have been able to achieve youthful looking results without surgery downtime or significant bruising. Cheers, Dr Eric O Shreder - Full Circle Wellness, Mesa, AZ

Kaete A. Archer, MD · Answer

Under eye bags (pseudoherniation of orbital fat) is a common complaint.  The eye area is one of the first areas of the face to show aging changes.  As the thin lower eyelid weakens, the fat pads are able to bulge/push forward and show up as bags.     
There are many options for under eye bags.  Each surgeon will have a different approach and technique based on experience and training.  The degree of under eye puffiness/bags (mild, moderate, severe), for me, is the most important factor when it comes to deciding on options.  
If the bag is mild and associated with a tear trough deformity/hollowness, my favorite option is a filler.  Like you mentioned, the filler can offer improvement but the result is temporary.   
Lower eyelid lift (blepharoplasty) is an option for you with long-lasting results.  There are several different surgical techniques that depend on your specific examination.  For some patients, especially younger patients who don't need to have excess skin removed from the lower eyelid, an incision can be done on the inside of the eyelid to avoid any scars.  The surgeon removes the part of the fat pad that is showing.  This results in a flatter lower eyelid.  If you have some hollowness under the eye, the surgeon can reposition the fat pads to blend the area.  The best way to piece these options out is to make a consultation with a qualified surgeon in your area.

Damon B. Chandler, MD · Answer

Lower eyelid "bags" can be caused by numerous changes in the lower eyelids and cheeks. Sometimes even younger patients (like you at age 30) have genetic causes of eyelid bags. Eyelid bags are often caused by protruding fat that is normal around the eye but has shifted out of place as giving an unpleasant appearance.  Your anatomy often contributes significantly to the appearance of the lower eyelid and upper cheek area as we get older.  Eyelid bags may go together with excess lower eyelid skin and a looseness of the lower eyelid itself. Typically non-surgical choices like skin care can hydrate the skin and improve the appearance of delicate fine lines.  But topical treatments are unlikely to effect "bags".  There are no photographs posted and so I cannot comment on your case specifically.  
Please make sure to have an in-person consultation with a board-certified, fellowship-trained Oculofacial Plastic Surgeon with specific expertise in cosmetic eyelid surgery and lower eyelid bags. During your consultation you can review lower eyelid blepharoplasty (lower eyelid surgery) and ask to see before/after pictures from the surgeon. Avoid doctors who do eyelid surgery part time as there are many subtleties and challenges to this procedure. You have one chance to have this delicate and precise operation done correctly the first time.  Best wishes!
Damon B. Chandler, MD
Harvard-Penn Trained Oculofacial Plastic Surgeon

Robert W. Sheffield, MD · Answer

Thank you for that question! Itis good to hear that you have opt for a non-surgical way before and have seen aslight progress from it. About your question, yes! There is definitely apermanent way on how to remove eye bags. There some options that could helpremove eye bags, but all of them are via surgical means. Some are minimallyinvasive, while others are aggressive. With eye bag surgery, your surgeon willremove or reposition the fat sitting under the eyes. At times excess skin isalso removed to achieve a cleaner and more natural result. After the procedure,the patient should be able to return to normal activities within 7 to 10 days,but full recovery may take anywhere from 4 to 6 weeks. This will be dependenton the skill of your surgeon, your adherence to after-surgery guidelines, aswell as the natural healing process of your body. 
To determine which kind of procedurewould work well for you, you may need to be assessed in-person by a boardcertified plastic surgeon. This surgeon should evaluate your case and find theseverity of the bags and the probable cause of it. This will help him ensurethat you are getting the right procedure to remove the said eye bags. Thetreatment that will be selected for you will be based on factors like yourdesired result, down time expectation, severity of the eye bags, and procedurecost. Do not be afraid to ask questions, doing so will help clarify things outfor you. Hope this answers your question!

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