I am 33 and just started getting under eye bags 6 months ago for no known reason. I've tried everything: vitamins, sleep, allergy meds, creams, water, etc., but nothing worked. I am considering laser, possibly Thermage or just going straight to a dermal filler or Blepharoplasty. What should I do? The pic doesn't show the puff much, but this is with makeup on. I have the purple crescent coming from corner of inner eye, then above that it is puffy and lighter colored. It is crepe-like when I smile.
Will a Filler or Belpharoplasty Fix my Under Eye Bags?
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Doctor Answers 11
Fillers vs. Blepharoplasty
Should I have surgery or filler treatment for my lower eyelids?
Under eye bag treatment
Treatment for under eye bags is usually surgery once you try the medical management as stated above. The surgery involves a trans-conjunctival approach on the inside of the lower lid to remove a conservative portion of the herniated fat located in the lower lids. The fat is below the skin and muscle and is taken out from the inside of the lower lids. For many examples, please see the link below to our eyelid surgery photo gallery
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Under eye bags
Your picture is hard to evaluate. You need to make sure you do not have any medical conditions leading to such a sudden onset of lower lid bags. See you PCP and resolve any medical problems before seeing a plastic surgeon.
Eye bags and more
There are many causes of eye bags. Some are shadow issues, some are discoloration issues. On the realm of this problem, from your photos, it appears you are on the mild end of the spectrum. I would start conservative (filler or fat transfer) and then if you are unhappy the ideal and most effective treatment for this is fat transposition. Make sure you see a surgeon who specializes in this though it is not a simple procedure. Below are some of the common causes of this problem with the treatment that varies depending on the cause.
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,
Options for Under-Eye Bags
As you are still young, injectable fillers such as Teosyal Redensity II or Restylane can all reduce the appearance of under-eye bags and, as they are a temporary solution, you can see whether you like the results and wish to continue. The best solution is usually blepharoplasty (eyelid surgery), which involves removing excess skin from around the eyes. The tissue will be tightened, and it’s possible that small pockets of fat will also be removed during the operation. These modifications can result in the significant reduction or even complete removal of bags underneath the eyes. Consult a qualified facial plastic surgeon in person for the option that is best for you.
Filler VS Lower Eyelid Surgery
All The Best!!
Fillers and Blepharoplasty may both be otptions
The bags under your eyes occur for several reasons-allergies, fluid retention, loss of skin quality, the fat pocket around the eyes starting to protrude among others. It sounds like you have tried many of the typical nonsurgical treatments without much improvement. So fillers or lower eyelid surgery may be the next step for you.
I see some patients who have a "hollowness" under the eyes. This is often called the tear trough deformity. If you have an area such as this the depressed area can be filled in with fillers such as Restylane, Juvederm or fat grafts. Each has advantages and disadvantages that can be explained to you by your plastic surgeon.
If you are developing some tissue laxity around the lower eyelids, the fat pockets begin to protrude creating the "bags" under the eyes. In this case eyelid surgery, (Blepharoplasty), may be the best, and longest lasting solution.
The best way to determine which solution is correct for you is to have a consultation with a board certified plastic surgeon experienced in eyelid surgery. He or she should explain the advantages, disadvantages, recovery and longevity of each procedure.
Blepharoplasty may be a good option, depending on the cause of the under eye bags
Under eye bags can be caused by a variety of factors, including diet, lifestyle and genetics. I see many patients like yourself who are young and healthy, and are starting to notice bags for the first time. Your approach is typical and appropriate - trying creams and getting more sleep is a good place to start. If these don't seem to be working, it is possible that the under eye puffiness is less related to fluid, and more so to the structures below your eyes.
As we age, some of us experience laxity of the muscle below the eye, which allows fat deposits to bulge forward and become more visible. If your under eye puffiness is in fact a result of fat pockets (slightly difficult to tell from your pictures - perhaps upload a side view), then blepharoplasty surgery may be an excellent option for you. My patients love this surgery as it produces noticeable, long-term results, and has a relatively easy recovery period. Most patients have little to no discomfort. As well, the procedure can often be done under local anesthetic with mild sedation. An additional benefit to you is that if you don't have loose skin under the eye (appears to be the case from the photo), you are a candidate for Transconjunctival blepharoplasty. When I do this procedure I make the incision inside the lower eyelid - which means no visible scars.
Fillers may be an option as well, however please keep in mind that adding filler to this area masks the signs of the puffiness, and does not actually correct it. With this type of treatment, the puffy lower eye area is camouflaged by filler material injected into the cheek area. In effect, the bulging fat and muscle that create the look of the lower bags are not specifically addressed, however following the treatment they appear to be less prominent beside the enhanced cheek area. Filler treatments need to be repeated and it is important that your physician choose a product that is safe and appropriate for that area of the face.
Laser can be used to resurface the skin to some degree, but can not address the root of the problem: fat pockets and muscle.
When it comes to Thermage, I have to be honest I have not heard any examples of noticeable long-term benefits from this procedure in the lower eye area.
I would suggest that you seek the advice of a Facial Plastic Surgeon in your area who will be able to give you expert advice on surgical and nonsurgical options.
Have a great day.
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.