Eye Bags, Circles, and Demarcations
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,
Permanent solution for eye bags
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.
Fat that normally rests around the eye is contained behind a wall called the orbital septum. As one ages, this wall can weaken and the fat can bulge forward . Having lower eye bags at your age is usually an inherited trait, not from aging. Some people are born with more fat than others and this can lead to more prominent bags as well.
The simplest procedure to essentially have permanent correction of this is to remove some of the fat from the lower lids. A more technically challenging operation, (one that I personally prefer), is not to remove the fat but to move it. This is called lower lid fat transpostion. This preserves the fat and prevents a hollowed look to the eye that can happen as one gets older. For both procedures, the incision is inside the eyelid and thus not visible.
Ask a board certified plastic or oculoplastic surgeon which procedure would be right for you.