Do I Have Prominent Under Eye Bags? Do I Need Blepharoplasty or Other Treatments?

A surgeon told me that my dark hollow circles were caused by prominent undereye bags which create shadows. I have seen this in others but can't see prominent bags under MY eyes. The doc said although mine aren't visible, they still create shadows & the ONLY solution is blepharoplasty to remove them. How can non-prominent bags cause significant shadows? Since I have hollows, wouldn't removal of tissue(?) make it MORE hollow? Do I have bags/need surgery? What approach would you recommend for me?

Doctor Answers 7

Please do not have a lower blepharoplasty for this.

"When you are a hammer, all the world looks like a nail."  I have no idea who said that but they are right.  If the only thing you know how to do for the lower eyelid is lower blepharoplasty, then guess what, that is what you are going to propose no matter what.  The treatment of choice now for your dark circle/under eye hollow is filling with Restylane not lower eyelid surgery.  You need to find someone who is very experienced in treating the lower eyelid hollow with fillers.  In Toronto you should have some excellent choices but you will need to do your home work.  Please do not have a lower bleph or fat grafting for this, you will regret it.  

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower Lid Problem but Not Fat Bags

Kim, I'm just as confused as you seem to be about your surgeons fat bags that are not.... Your sliver of a photo must show the entire problem which seems to be a tear trough deformity. Surgeons who are good at fat grafting usually recommend fat and show good results. The fall back position would be fillers for this area. Understand that this area of the face requires experience and accuracy regardless of the technique used.

Paul S. Howard, MD, FACS
Hoover Plastic Surgeon
5.0 out of 5 stars 7 reviews

Video on Eye Bag Treatment: Your eye bags are not severe

You situation is part of normal aging. The eyebags are really just related to loss of volume from aging. Removing these eyebags with a lower eyelid lift will lead to a result that you may not like even though this is a standard approach for this situation. I would suggest either fillers in the under eye hollows or fat injections or young volumizer.

Thanks for reading, Dr Young

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 86 reviews

Lower eyelid shadow

Given the logic which does not seem clear to you your concerns are valid. Based on only the small narrow slit photo you posted it is impossible to say what would be best in your case.

If you shine a direct light on the area you feel is dark and the darkness goes away it is a shadow. Once you are clear it is a shadow then you have to figure out what is causing the shadow and then find out what options are available to address that problem. This should be done by your prospective surgeon during a face to face consultation. If he/she will not or cannot do it you need to visit another surgeon. In cosmetic surgery there is never only one solution anymore. There are several and as technology improves the option list keeps growing. The best option in my experience though is usually but not always the one that has been around the longest.

Your photo shows a tear trough deformity which is thinning of the soft tissues over the bone rim under the eye. There may be some additional protrusion of fat into the eyelids above this level. If you do the classical lower eyelid blepharoplasty with removal of fat in the lower eyelid it will do nothing for the tear trough and would likely make the bone rim even more visible. More and more doctors are using injectable fillers to treat the tear trough especially when the lower eyelid bags of protruding fat are not very severe.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Lower eyelid bags and eyelid surgery

  Your photo is quite small but from what I can see, there does appear to be evidence of lower eyelid bags that would be reduced with a lower eyelid surgery.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Based on your photo, you appear to have lower eyelid grooves that may be improved by an Injectable Filler treatment.

I read your concern and reviewed the photo of your lower eyelids:

You have some reddish discoloration of your thin lower eyelid skin that could be due to a number of factors: chronic nasal allergy or possibly dermatitis.

Beneath this, you appear to have fairly typical lower eyelid grooves that may be improved by a well-performed Injectable Filler procedure. This would allow your lower lids to blend more harmoniously into your cheeks, and make the "hollow circles" less prominent. My personal preference is to use Silikon-1000, an off-label filler for permanent results.

I agree that lower blepharoplasty may exacerbate a hollow appearance.

If you're considering an injectable filler treatment, make sure your physician is skilled in the delicate art of filling lower eyelid hollowing. You should see many favorable photos before moving forward, as this is an unforgiving area for fillers.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 421 reviews

Eyelid hollowness

The lower eyelid subtleties are sometimes difficult to tease out, especially in the photo that you have presented. However, in general, the "dark circles" on the lower eyelids maybe caused by a variety of factors:

a. skin pigmentation

b. thin skin revealing the underlying muscle and/or vessels

c. shadows created by light along irregular contours [either bulginess or hollowness, or a combination of both]

In your case [ and again your photo is less than ideal] it appears that you have a trough [or hollowness] between the eyelid and cheek.  You do not seem to have prolapsed fat of any significant degree. In addition, you seem to have some prominent vessels that are visible as well.  Fillers [restylane, juviderm, or fat injections] by an experienced surgeon injector would be the most appropriate solution for you. This will not address the prominent vessels, but will fill in the hollowness that is may be the culprit.

Obviously, an "in-person" consultation, or photos done in multiple views would be more helpful

AJ Amadi

seattleface com

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 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.