What treatment would you recommend for eye bags, lost volume in apples of cheeks after weight loss? (photos)

Since I lost 65 lbs I have really awful eye bags and no volume left in my cheeks. I look sad and tired all the time. Whats the best method of improving this area? The most affordable?

Doctor Answers 4

Options in treating puffy eye bags and addressing facial volume loss

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As a specialist in facial aging and cosmetic oculofacial plastic surgery practicing in Manhattan and Long Island for over 20 years, I deal with this type of problem every day in our practice. I approach this situation by first defining the problem and discussing the different options based on the level of long-term benefit as well as affordability.

Bags under the eyes are the result of lower eyelid fat prolapse. Lower eyelid prolapse means that the fat that is normally around your eyes has pushed forward and results in puffiness under the eyes. Under eye bags or the fat around your eyes is the last fat in the body to go away when someone loses weight. This is common in people in malnourished situations where much of their body’s natural tissue in addition to muscle is broken down, so losing more weight will not help in under eye fat pockets going away.

The approach to lower eyelid fat prolapse is to perform lower eyelid blepharoplasty. This can be done in two different approaches: one is from the outside called a transcutaneous approach and another is from the inside called the transconjunctival approach. For most of our patients, we perform from the inside of the eyelid called transconjunctival blepharoplasty to avoid an external incision. The decision on the approach is based on physical examinations. The lower eyelids are deceptively complex and many plastic surgeons end up having the lower eyelid pulled down or retracted and sometimes even everted. The lower eyelid has a lot of critical important anatomic structures that need to be in balance in order to get good results.

When we evaluate the lower eyelids, we also look at skin quality and texture. We would consider procedures such as fractional CO2 laser as well as the use of platelet-rich plasma derived from your own blood in order to stimulate new collagen and to improve the skin quality.

The apples of your cheeks are an area which we refer to as the malar fat pads or the submalar space. When someone has lost volume in this area, I also perform a lot of facial rejuvenation surgeries such as face lifting, cheek implants, etc. I try to decide how much volume was lost from your weight loss and from sagging or descent. When the face descends when one gets older, plumping it out might not look so good because the skin doesn’t have the tone or the resilience to hold that volume. So in the mid facial area, augmentation can be performed with a facial implant such as a submalar implant or a filler such as Radiesse and Restylane. I also tend to use platelet-rich plasma to further enhance the volume in this area. I would also do fat grafting which is taking fat from one area of the body and place it into this area to augment it further.

In terms of affordability, I come up with different scenarios for my patients. As long as the patient understands what those scenarios and what the costs are, I try to come up with a structure that is affordable but is also satisfactory. A lot of people buy lower priced options and they end up wasting a lot of money. High quality and cost do often go hand-in-hand. This is an investment where you will reap the benefits after a long time. As long as you communicate with your doctor, you should be satisfied. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Treatment of eye bags

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Thank you for including photos.  I don't think that you would get the best result with injectables.  However, a lower eyelid blepharoplasty (eyelid lift) with fat repositioning to fill in the hollow under your lower eyelids should provide you with very nice improvement.  It would be best to seek the advice of an experienced plastic surgeon in your area.  

Laurence Weider, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 102 reviews

Lower Eyelid Blepharoplasty

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Thank you for your question and pictures.

When your weight stabilizes, you would likely enjoy the benefits of a lower eyelid blepharoplasty with fat repositioning.

To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

What treatment would you recommend for eye bags, lost volume in apples of cheeks after weight loss?

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In my opinion, the best treatment would be a lower blepharoplasty using the fat positioning technique.  This will significantly help improve the tear trough (groove below the eyelid bag) and smooth the transition from your eyelid to your cheek.  Using a blepharoplasty technique that removes the eyelid bag (which is fatty tissue) will create a hollowed and older appearing eyelid area, thereby not rejuvenating your appearance.

Additionally, combining the blepharoplasty with fat augmentation to the cheeks and the surrounding peri-orbital area would further enhance the results.  The link below provides more information.

I hope this helps.

Timothy R. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 74 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.