Will a Filler or Belpharoplasty Fix my Under Eye Bags?

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.

Bags under the lower eyelids are usually caused by displaced fat, redundant muscle, redundant skin, or sometimes even a prominent vascular plexus giving the aesthetics of lower lid bags or dark circles.
Early volume loss in your upper cheek and tear trough area can exacerbate even a small amount of genetic predisposition to having eye bags. There are numerous, good options to address this issue ranging from nonsurgical to surgical.
It is important to realize that it is displacement of fat, NOT excess fat that can cause lower lid bags. Old school blepharoplasty approach took skin and fat out of the lower lids by cutting right through the skin, which gave long term poor results with hollowed out lower lids and more potential for surgical complications. 
We know that we tend to lose fat as we age in our face, so taking more out as part of a surgical procedure may look good immediately, but it is a long term bad idea. Newer approaches to lower lid blepharoplasty do not cut through the skin and leave no external scars, this is called the transconjunctival approach. More important yet, the existing fat is repositioned instead of removed, giving much better long term results with a more conservative surgical technique that also has lower potential for complications. 
Nonsurgical options include strategically placed volume to replace early loss, which can have a dramatic impact on the appearance of eye bags and the junction between your eyelids and cheek. Volume can come in the form of fillers or as micro fat grafting. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

An examination by board certified plastic surgeon would be required for the best answer. That being said from your description and photos it would appear that you might be a typical patient for a lower lid blepharoplasty that redistributes your fat rather than simply removing it to prevent hollowing.

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.
Dr Z

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

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!!

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.

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.

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.

Thank you for your photo and questions. It seems that you may have multiple components that are contributing. The crepe-like appearance is likely to do well with laser treatment, as you mentioned you are considering. If you feel like there are lines around your eyes that accentuate when you smile, you may see some benefit from neuromodulators (Botox, etc) as well. The bags that you have under your eyes are fairly well defined in the photo, which suggests they are probably related to prolapsed orbital fat that could be addressed with blepharoplasty. However, they do look somewhat pinkish red in the photo, which suggests a component of dermatitis or another source of inflammation. This should be controlled before proceeding with cosmetic procedures. I recommend seeing an oculoplastic surgeon, an eye doctor specifically trained in diagnosing and treating conditions of the eyelids and surrounding area, to make sure you're medically optimized and to set you up with a treatment plan that addresses your concerns.