What can I do about my under eyes? I've had this problem for a long time now. (Photo)

I've had this discoloration and bulging for a long time now and I feel like I'm too young for this look. Any advice is appreciated.

Doctor Answers 12

Under Eye Bulge and Discoloration

The bulge is due to excess fat in your lower eyelids. This can be removed via a transconjunctival incision to spare you a skin scar. Said differently, an incision on the inside of your eyelid can be used to tease out the excess fat. The discoloration is a separate issue. It's a tough issue to eliminate. Swelling, congestion, allergies, and plain old genetics are often to blame. I'd put you on a skin care regimen with the intention of using products to help lighten the skin on that area. I'd also use light-based treatment to lighten the pigment in your skin.

Tear Trough Filler

Thank you for sharing your question and photo. The problem you are noticing is very common and often due to loss of volume in the under eye area causing a "hollow" appearance. The easiest fix is carefully injecting a hyaluronic acid filler into this area to offset the volume loss. In my practice, I have had excellent success using Restylane for this area as it provides a very natural aesthetic. I also prefer to use the microcannula technique (instead of the traditional sharp method), which minimizes bruising and allows filler to be evenly injected using only one entry point. I recommend consulting with a board-certified surgeon who has experience using the mircocannula technique in the tear trough area. Best of luck!

Kian Karimi, MD, FACS
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Rejuvenating under eye area

It is hard to make recommendations based on one photograph.  Very often the appearance of bags are related to bony changes in the face over time as well as volume loss due to fat loss in the fat compartments of the face. Often times we find that lifting and supporting the cheeks with Radiesse can augment the eyes and balance the features. We can further correct the delicate under eye area by using thinner and softer hyaluronic acid fillers such as Restylane.  It is an off-label treatment and is best done by a trained oculoplastic surgon.  Dark circles maybe due to a combination of shadowing as well as hyperpigmentation.  Hyperpigmentation can be often treated with topical products, such as hydroquinone and vitamin K, as well as light chemical peels and Intense Pulse Light laser treatment.  The shadowing can also be improved significantly with injectable fillers.
Seek out a trained injector surgeon who specializes in aesthetic medicine to find out all your options. Best of luck. 

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 64 reviews

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Under eye bags

Hello and thanks for posting your question!
The quality of the picture you sent is not ideal for assessment. That being said, under eye solutions range from noninvasive peels and lasers to help tighten skin and improve texture all the way to surgical excision of skin and fat. Based on what I see, you may benefit from skin improvement +/- excision of protruding fat in the under eye area. Fat excision in people who are otherwise young and with no skin excess can be done with a hidden incision of the inside of the lower eyelid. 
I find that fillers typically do not correct the under eye shadows as much as we would like them to and most patients typically turn to surgical options after being unsatisfied with fillers in this particular area. 
Best of luck to you in reaching your goals!

Bags

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
New York Facial Plastic Surgeon
4.6 out of 5 stars 87 reviews

Treatment for lower eyelid bags

Thank you for sharing your question. The bags can be treated by lower eyelid blepharoplasty or with the injection of Restylane. See an experienced eyelid expert in person for comprehensive evaluation and discussion of best treatment options.
Good luck,

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

The eyes are best treated with a combination approach of fillers, lasers, microneedling/PRP for improvement. Ultherapy/thermage, venus legacy all do well for swelling or puffiness. I would suggest consulting an expert. If surgery is an option they will recommend. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 166 reviews

Lower lid bags

Hi there,
It's likely you have prominent fat pockets causing this issue.  It can happen in all ages, your options include either filler injectables vs lower lid surgery (blepharoplasty). Fillers are generally recommended when you have hollowing along the lower eyelid/midface area more so than prominent fat pockets, and surgery is recommended when you have prominent fat pads. I would recommend you seeing an eyelid expert (ie oculoplastic surgeon) to discuss your best options. Good luck!

Okay, that is truly a bad photograph.

This may or may not be herniated orbital fat.  I can't tell from this photograph.  I suspect that it is not herniated orbital fat.  Look straight ahead in the mirror. Put your finger on top of the "bag."  If what your are feeling is hard, then this is your orbital rim.  Filler would be your very best option if that is the case and not eyelid surgery.  If you are serious, get several opinions from eyelid surgeons in your area.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

FAT REMOVAL

Trying to hide truly herniated fat with fillers is often disappointing. These photos are not adequate for reliable recommendations.  A thorough physical examination is required for intelligent analysis and options.

That said, you may be a candidate for a simple trans-conjunctival blepharoplasty.  Excess fat is removed from the inside of the eyelid. No visible scars, no sutures. This is reserved for patients with herniated fat, but no excess skin.  See video.

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.8 out of 5 stars 9 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.