Will a Filler or Belpharoplasty Fix my Under Eye Bags?

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.

Doctor Answers 10

Fillers vs. Blepharoplasty

It is difficult to judge from your photograph how puffy your eyelids are and assess the reason for your "purple crescent". If your lower eyelid has a mild bag, then a filler injected inferiorly to it (below) may hide the problem and improve any darkness caused by a shadow. If the bulging is more substantial, then the fat should be removed by blepharoplasty. Irregular pigmentation of the skin can be removed at the same time with an Erbium laser to achieve an overall enhanced appearance. All the best.

Should I have surgery or filler treatment for my lower eyelids?

Lower Eyelid Bags can be caused by many different issues. Sometimes a combination of issues are contributing to the dark, heavy look of the lower lids. Changes in skin, fluid accumulation, muscle, fat from the eye socket, and changes in the cheek and surrounding structures can all contribute. It is important to have an experienced physician evaluate your eyelids to determine all the changes that need to be addressed to achieve your goals. Surgery is an option especially if there is excess fat. From your photos, it appears the biggest issue you have is hollowing, and thinning of the skin. In your case, in office procedures can be used to improved the shadowing and baggy appearance of the lid. I commonly use injections such as Restylane, and Voluma in combination with skin rejuvenation to improve the lower eyelids without surgery.

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 11 reviews

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

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

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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,

DrC


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

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.

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 114 reviews

Filler VS Lower Eyelid Surgery

Thank you for your question, however due to the quality of the picture it is very hard to assess. Filler is a good temporary solution, Judeverm is what most my patients like. Where lower eyelid surgery (blepharoplasty) is a permanent solution aims to address the bags under the eyes. Excess skin and removal or reshaping of the fat smooth’s the contour between the lower eyelid and the cheeks. Please seek advice from a board certified oculoplastic surgeons who will be able to assess you and advise which route to take.

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.

James H. Schmidt, MD (retired)
Sarasota Plastic Surgeon
5.0 out of 5 stars 7 reviews

Blepharoplasty may be a good option, depending on the cause of the under eye bags

Hello,

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.

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
5.0 out of 5 stars 100 reviews

I wonder if there is a hereditary component to your

This is usually the result of fat pads bulging and topical treatments can not help.  Surgery is the best option and can be done either from the inside of your eyelid or from the outside.  The color of the skin can be improved with laser treatments.

Blepharoplasty fixes puffiness under eyes.

When puffiness is always there under the eyes, not just there sometimes, surgery to remove it is your best option. Fillers can be placed below the puffiness to soften it, but we do not want to fill the cheek area up to the puffy area.  Laser may also help to soften the crepiness, and discoloration. With your dark eye color and complexion start with non resurfacing lasers and work up to the carbon dioxide laser if you do not achieve the results you are looking for.

Brian Maloney, MD, FACS
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 25 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.