How can you tell if it's really fat what hiding under your eye lids?

Fat below the eyelids is contained in two compartments in the upper eyelid, and three compartments in the lower eyelid. After ruling out a history of allergies, or medical conditions that can lead to swelling around the eye then it's possible to proceed with cosmetic eyelid surgery.Excess fat can be removed during a blepharoplasty procedure. In the upper eyelid the fat is removed after excising the excess upper eyelid skin. In the lower eyelid the fat is removed by making an incision inside the lower eyelid. This allows access to the three fat compartments as needed. Lower eyelid skin can be removed if needed by performing a pinch blepharoplasty. This uses an incision directly under the lower lid lash line to remove excess skin. Overall, blepharoplasty incisions heal very well and it's very difficult to determine that someone has had a surgical procedure the patients are left looking more youthful and refreshed.

The short answer is training and experience when examining a patient.  Fat behaves differently that other things. Location matters too.  Best to see an oculoplastic surgeon for evaluation.

This assessment is part of a detail oculoplastic consultation.  The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a regional directory on their website that can help you identify a highly qualified surgeon close to home.

Thank you for your question.  As you indicate, there are many reasons to have puffy, tired looking eyes that range from allergies, sleep deprivation, heredity to aging and fat prolapse.  The most helpful way to evaluate this would be to see someone in consultation who can evaluate your eyes and tell you about your options.  But to answer your question, do your under eye bags go away after a good night's rest (such as on the weekends)?  If they do not satisfactorily vanish, its probably not due to lack of sleep.  Allergies can also be a contributor, so if you have allergic symptoms (runny nose, itchy eyes, etc.), then you should look into treatment for this of course.  I hope this can at least get you started, but once again, there is no substitute for a consultation with someone who is an expert in this field.  Good luck and all the best!

There are 3 small compartments of fat in each of the lower lids that become herniated over time and create the "puffiness look" or "tired look". A trans-conjunctival lower blepharoplasty  with the incisions placed on the inside of the eyelid can remove the bags which are creating the puffiness. For many examples, please see the link and the video below

There  is a simple clinical test we use to determine what the bulge is. Take your cell phone and record a "selfie video."  While recording, close your eyes and gently press on your eyeballs.  If you have bulging fat under your eyes, the fat will bulge more when you apply pressure to your eyeballs. Press, release, press, release.  The video will tell you what your problem is.

There is no reliable test that you can do at home. An examination including taking a medical history would be the best way to determine the cause of your concern.If it concerns you enough to do anything about it, I would suggest that you find a plastic surgeon that you are
comfortable with and one that you trust and listen to his or her advice. The
surgeon should be certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS).
You should discuss your concerns with that surgeon in person.

Robert Singer, MD
FACS

La Jolla, California

Dear Inovak, During consultation and examination your surgeon can determine if you have fatty deposits under the lids or if this is "puffiness" caused from other factors. Fatty deposits respond differently then water retention, hereditary" sad pads" are located differently then fatty deposits, etc...There are many factors in diagnosing a patients candidacy for lower lid blepharoplasty and an experienced surgeon will will have no problem doing so correctly. Best regards, Michael V. Elam, M.D.

This is a very good and commonly asked question regarding upper and or lower eyelid bags.  Fat bags of the upper or lower eyelid remain throughout the day unchanged whereas eyelid swelling from any cause tends to disappear by early afternoon.  Hope this helps.

See a board certified plastic or oculoplastic surgeon. The doctor will have no trouble telling youwhat the problem is and give you suggestions for improving the apearance.