Help! I'm a 42 year old female and my under eye bags are making me crazy. What do you recommend? (photos)

Doctor Answers 12

Best treatment option for lower eyelid bags

Some of the treatment options for lower eyelid bags and hollowness are fillers, fat grafting and lower blepharoplasty. In my opinion, if you want the best aesthetic outcome that last a long time would be lower blepharoplasty with release of arcus marginalis and fat redistribution. This would correct both the puffiness and hollowness along the lid/cheek junction. 

New York Plastic Surgeon
4.6 out of 5 stars 50 reviews

Eyelid surgery

Dear pm, thank you for your question. Blepharoplasty or eyelid surgery can remove loose skin and bulging fat pockets, and enhance the appearance of the upper face. In our San Diego practice we often combine eyelid surgery with fat grafting or a laser peel for best results.Eyelid surgery is not without risks, so consult with an experienced facial plastic surgeon or general plastic surgeon to discuss your options. Good Luck!

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 23 reviews


I would recommend removing some of the fat from the fat pads under the eyes and taking a pinch of skin as well as a fat transfer to the hollow underneath.  That would smooth everything out nicely.  A similar procedure on the upper lids would really open up your eyes.  

Jan Zemplenyi, MD
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Lower blepharoplasty for puffy lower eyelids

You appear to be a good candidate for lower blepharoplasty with fat repositioning, where the puffy bags (fat) is moved into lower position to fill the hollow area.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Under eye bags?

Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: Temporary fillers, micro-fat grafts, blepharoplasties, or a combination of those options.There is no one best procedure. Each has benefits and drawbacks.

Following the advice of anyone who would presume to tell you what to do without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. 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

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

Help! I'm a 42 year old female and my under eye bags are making me crazy. What do you recommend?

You probably would benefit from blepharoplasty with fat repostioining and laser resurfacing of your crepe skin.  Fillers can sometimes accomplish the goal as well.  See an Oculoplastic surgeon.

Sam Goldberger, MD
Beverly Hills Oculoplastic Surgeon
4.7 out of 5 stars 16 reviews

Blepharoplasty with fat grafting below the puffy area is an option to consider

A blepharoplasty can be done to remove the puffiness which is caused by fat.  You also have a depression beneath the puffiness which can be filled with an open fat graft.  You may also need a skin pinch to tighten excess eyelid skin.  For more information read to the link below.

Under eye bags

You have some prolapsed orbital fat, but you are also pretty hollow through the whole area.  You would benefit from a blepharoplasty, with some fat transfer into the area to fill in the hollows.  This will be a much more permanent solution than fillers.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Filler versus surgery for lower eyelid bags

the collection of comments that are listed below are all very accurate.  In general he would want to get her consults performed with someone who is an experienced eyelid surgeon.  Board certified facial plastic surgeons and oculoplastic surgeons (there is no Board certification for this so do not let that concern U) would be the best place to start.  Depending on what we find during her physical exam you could be a very good candidate for filler or surgery.

Best of luck

Chase Lay, MD
double board-certified facial plastic surgeon

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

You might do ok with under eye fillers.

Or under eye fillers might just be a nightmare.  First the amount of filler that you will need to build up the top of your cheek would be significant-possibly on the order of 2 milliliters of Restylane under each lower eyelid.  Do not even consider Juvederm or Belotero for this application. Done well, the result can be fantastic.  However, it is a fussy service.

I would recommend a careful consultation to consider lower eyelid/midface surgery.  I would consider a hybrid lower blepharoplasty done from the front and back of the lower eyelid.  This would include an internal transconjunctival blepharoplasty with arcus marginalis release to use the lower eyelid fact to fill the hollow at the top of the cheek and and skin only transcutaneous lower approach to resupport the sagging cheek.  My lower eyelid webpage has examples of this type of work.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.