What would you recommend for these under eye bags? Are fillers worth the risk? (Photo)

i have deep bags and dark circles even though I rarely drink alcohol and sleep a sound 8-9 hours a night. I'm ready to look wake again! What should I do?

Doctor Answers 15

What would you recommend for these under eye bags? Are fillers worth the risk?

An in-office examination is required to offer the best recommendations.

Typically eyelid bags are best treated with a lower blepharoplasty procedure (with or without fat transfer).  Fillers to the area do not correct the eyelid bags (which are, simplistically speaking, herniated fatty tissue).  Fillers, even when done perfectly, only camouflage the bag in certain lighting and eye positions, and truly most people are not good candidates for fillers.

The attached link provides more information.

I hope this helps.


Orange County Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Fillers are generally safe, but can only treat slight under eye bags. Surgery is a more definitive, long-term treatment

Thank you for your question. You’re concerned about deep under eye bags and dark circles, so you’d like to know how to address them. You’re also wondering whether fillers are worth the risk.

I can certainly help you with this question. To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. Improving the appearance of eye bags and dark circles has always been a big part of my practice, so I can certainly give you some guidance.

To understand how under eye bags and dark circles can be addressed, we have to define the anatomy and then the possible options. First and foremost, under eye puffiness is usually caused by lower eyelid fat prolapse where the fat around your eyes is pushed forward, creating these bags. Several years ago, it was learned that hyaluronic acid fillers could be used to help mask the appearance of mild under eye bags. Nowadays, some physicians are still trying to address under eye bags by adding more filler around the eyes, though this often only leads to emphasizing the eye bags even more negatively. As a result, patients often need to get hyaluronidase in order to dissolve the unwanted volume.

When dealing with under eye bags, it is advisable to deal with them more definitively via a procedure called a transconjunctival blepharoplasty. This procedure is performed under LITE™ sedation, and allows the surgeon to address the fat pockets from inside the eyelid. In addition to this, I would also do a combination treatment of platelet-rich plasma and fractional CO2 laser for skin quality improvement. Platelet-rich plasma is a concentration derived from your own blood and is made up of wound healing factors that stimulate the body to form more collagen and improved blood supply, while fractional CO2 laser tightens the top layer of the skin and reduces the appearance of wrinkles.

Many people opt for fillers because they feel that they are less invasive. I say otherwise because once you pass the needle through the skin and place a foreign material underneath the skin, that is already considered an invasive procedure.

When dealing with cosmetic concerns of the eyes, it is important to understand that the cheeks also play an important role. The cheeks actually accentuate or frame the face, so placing volume in this area, at a much deeper level, can do wonders for the overall balance of the face. A technique that can help achieve this is called structural volumizing, and certainly fillers do play an important role in this.

Ultimately, this is an art, and if you consult with several different doctors about this, you will most likely get several different answers and ideas. What is important is to be properly informed of the different methods and options there are in addressing your concern. I recommend that you meet with experienced specialists, find someone who you are comfortable with, and find someone whose work you feel confident in. It is also important that you find someone who spends enough time understanding your cosmetic concerns, and someone who can properly explain all the possible options to you.

I hope that was helpful and I wish you the best of luck!

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Fillers

Yes, fillers are definitely worth it. I use Restylane on myself and love the results. Schedule a constellation with a board certified plastic surgeon in your area to be assessed in person and discuss options. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 51 reviews

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Fillers worth the risk

You have a deep tear trough as evident from the photos, fillers can be injected with minimal discomfort using a cannula to minimize pain/bruising/discomfort.  The fillers need to be repeated but can last up to one year, and on some occasions even a year and a half.  However, if you compare cost/benefit/duration, your degree of fat bag prolapse (herniation) is best improved with a lower blepharoplasty with fat reposition to pad the tear trough or filling the "valley" with your own orbital fat for potential long term 7-10 years.

Johnny Mao, MD, FACS
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Fillers

I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

Elliot M. Heller, MD
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Lower lid bleph

From these photos, it looks like you would get a homerun result with an lower lid blepharoplasty. This procedure would make you look more rested. In my experience the most important thing in assuring a quick recovery from blepharoplasty is minimizing bruising and swelling. Bruising is much easier to prevent that to get rid of. I have all my patients ice as much as possible from the time they get home until they go to sleep that first night. And I instruct them to not recline any more than 45 degrees until they go to sleep that night. And stay away from salt. Patients who follow these instructions generally heal very quickly with little or minimal bruising or swelling. See a board certified surgeon in your area with an expertise in aesthetic surgery for more information. Good luck with your procedure!

Dean Vistnes, M.D.
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#realself #drdeanvistnes #blepharoplasty

M. Dean Vistnes, MD
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Under Eye Bags

Thank You for your question. There are several options for you to choose from. Surgically, would be a Blepharoplasty. Non Surgically would be fillers, ie. Restylane or Juvederm Voluma. I would recommend you see a Board Certified Plastic Surgeon to determine which treatment would best fit your needs. I hope this helps and good luck to you.

Camille Cash, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews

Filler for eye bags

A combination of filler and skin care would completely refresh and rejuvenate your appearance without surgery.  Fillers, in the hands of an experienced injector, offers far fewer serious complications than lower eyelid surgery, and is (depending on the injected substance) totally reversible.
See a board-certified plastic surgeon with experience in both filler and surgery for an examination and to discuss your options.

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
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Under Eyelid Bags

Your photographs reveal protrusion of your lower eyelid fat , an associated "tear trough" or inner eyelid groove  and mid facial volume loss. In regard to your eyelid "bags" you could start with lower eyelid injections of Restylane or Belotero to fill in the "groove" in order to camouflage the protrusion of fat. If you want a more  long lasting fix then you could have fat repositioning performed from an inner eyelid incision(transconjunctival approach) . In addition,because the depression over your cheek bones is contributing to your fatigued appearance I would augment soft tissue over the malar depressions with Voluma, Restylane Lyft or your own fat.  

Joel E. Kopelman, MD, FACS
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Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

I use a combination of fillers, lasers, microneedling/PRP in my practice with great results avoiding surgery.  Best, Dr. Emer.

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