I'm a 32 yr old male with under eye bags and dark circles. Is topical treatment, or surgery the best option in my case? (photos)

I have mild allergies; I'm a stomach sleeper, and my mom has pronounced bags and dark circles as well. Also the area above my eyes and to the sides are red and/or purplish.

Doctor Answers 5

Dark circles can have many causes in a male or female

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Your dark circles are caused by a few different things, most of them being familial, or genetic, so it's not surprising that your mom has similar findings.  Naturally, as a person ages, these things can become more pronounced.  One of the factors contributing to your dark circles is probably pigment showing through the very thin (thinnest in the body) skin of the lower eyelid.  The underlying muscle and blood vessels sit right beneath the skin without any fat covering them, so the color shows through very easily.  Also, some families have some additional pigment in the skin itself, and this can contribute too.  These two things are really difficult, if not impossible to do anything about.  Most people will use some form of concealer to cover these as there is no laser or other topical treatment that can do away with this permanently.

The second thing that I can see that is contributing is your anatomy around the eye, and that is something that we can help.  You have a very flat, small maxilla and orbital rim relative to your eye, and this creates something we call a "negative vector" relationship in which the eyeball protrudes more than the bony orbital rim and cheek.  This is a warning sign for surgeons to be very careful about how bags and protruding fat are managed.  What you need is volume under the orbit, or eye socket, to blend in with what is otherwise a normal fat volume above.  It just looks like it's protruding because the orbit is small, the eyeball is big, and the cheek bone is recessed.  If someone were to simply remove that fat from the orbit, say with a transconjunctival blepharoplasty, you would look hollow, and your eyeball would appear even more prominent.  What you need is to either have the bony rim area built up with something or have the fat in your orbit around your eyeball "rearranged."  The fatty "rearrangement" (transposition) is something that can be done through your eyelid inside or from the outside depending upon the surgeon's assessment and recommendations for your specific case.  That may be more than a young guy wants to go through right now, so you can also have the area very effectively camouflaged with injections of fillers or even some of your own fat from elsewhere on your body.  There are many different fillers on the market that will work here; each surgeon will have his or her preferred technique.

My best advice is to find an experienced board certified plastic surgeon, facial plastic surgeon, or occuloplastic surgeon who has a good working knowledge of the anatomy of that area and experience in all forms of treatment for this, so that you will get a good evaluation of your problem in person and then hear about all of the available options to address it.  Good luck.

San Diego Plastic Surgeon

I'm a 32 yr old male with under eye bags and dark circles. Is topical treatment, or surgery the best option in my case?

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Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary fillers, micro-fat grafts, blepharoplasties, or a combination of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

Following the advice of anyone who would presume to tell you what to do based on limited photos and more importantly without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Bags and dark circles under eye

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You appear to have a combination of fat pad protrusion and pigmentation issues within the skin. A lower blepharoplasty will help both whereas filler will be only short-term and only mildly help the bag issue.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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You appear to have herniated orbital fat but this needs to be confirmed a consultation.

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More significantly, you have a profound negative vector relationship between the eyes and the mid face.  Almost any surgical procedure has the risk of pulling the lower eyelids down.  Fillers may be helpful.  Lasers are not really that helpful.  I recommend finding a highly qualified oculoplastic surgeon to help you assess the situation.  The American Society for Ophthalmic and Plastic Surgery maintains a regional directory of fellowship trained oculoplastic surgeons on their website that can assist you with your goals.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Under eye bags and dark circles

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You appear to have a combination of problems causing your eyes to look more tired.  The under eye bags are due to fat coming forward from the eye socket along with loss of fat volume in your upper cheek. The upper eyelid skin changes are due to the thin skin showing shallow blood vessels underneath, and some skin pigmentation differences, both of which are just part of your DNA.  Filler or a lower eyelid blepharoplasty with fat transposition could help the lower lids. There are various treatments for the skin changes, which you can read about in an article I've linked to below.  

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

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.