I have hereditary under eye bags. I inherited them from my grandmother. I've had them my whole life. Any advice? (photos)

Genetics is a very big factor in the presence of eye bags. It is
related to the anatomic structure of the septum or the sheet that separates the
front of the eye to the back of the eye. In under eye bags, there is fat behind
the septum. When fat pushes forward, it’s called herniated fat. A lot of
patients come to us after trying creams, teabags and all kinds of different
things and find out that none of them work because what you are dealing with is
an anatomic issue.



There are two ways to address the fat pockets: one is from the outside
called the transcutaneous blepharoplasty, and from the inside called the
transconjunctival blepharoplasty. For someone like you, we would typically do a
combination of things to address the different aspects of lower eyelid
rejuvenation. We address the fat pockets and also address the skin quality and
the volume issues that also coincide with this puffiness. We commonly do a
transconjunctival blepharoplasty which means addressing the fat from the inside
of the eyelids. We would combine that with platelet-rich plasma (PRP) which is
derived from your own blood. It’s a concentration of the growth factors that
are used for healing. By placing these growth factors under the skin, it
generates collagen and improves the blood supply to the skin. It adds a nice
quality to the under eye area which often has a lot of shadowing and wrinkling.
Last but not least, we often use a fractional CO2 laser. There is certainly a
role for a limited amount of thermal energy to tighten and stimulate collagen
from the external approach. It also refreshes the top layer of the skin.



I agree with you that fat transfer is not the solution for you. I have
many colleagues who have tried in vain to use fat to augment and restore
volume. Part of the basis of this is the fact that we lose fat and volume in
the cheek and in the facial structure as we get older. Unfortunately, the skin
doesn’t tolerate that much volume and between 30-70% of the fat can be absorbed
by the body. Inflammation and scarring of the fat can create irregularities and
lumps. I have patients who come to me from all over the world who have had fat
transfers done elsewhere and requested that I try to remove this fat. It is
technically very challenging and it is always a more complex operation than
doing a lower eyelid blepharoplasty.



In addition, be mindful of your anesthesia options. We perform these procedures
under local anesthesia with LITE™ IV sedation, meaning we don’t use general
anesthesia. We perform these procedures in our own Joint Commission-certified facilities.
Therefore, we basically have the benefits of a hospital structure, equipment, process
and personnel, but in a more relaxed and familiar setting.



Addressing under eye bags really makes a remarkable difference in a
person’s appearance. They look less tired and more energetic. It’s almost like
doing a facelift without doing a facelift. I recommend that you meet with some
qualified experienced cosmetic surgeons and find someone who resonates with
you. I hope that was helpful, I wish you the best of luck, and thank you for
your question.



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Hereditary "eye bags" are quite common and can make the eyes (and you) falsely appear tired and sad when you otherwise are not.  I agree that fat augmentation (although an excellent procedure) may not be the best option for you.  Lower eyelids bags are (simply stated) a "hernia" of fatty tissue.  Fat augmentation and fillers do not correct the "hernia only camouflage the bag.  Like a hernia in the abdomen or groin a surgical procedure is typically the best procedure.  Consequently, a lower blepharoplasty using the fat repositioning technique would be your best option.  However, the most accurate recommendation can only be made after an in-person consultation, which includes a thorough review of your medical history and physical examination of your eyelid area.The following link provides more information.I hope this helps.

Most expert experienced artistic plastic
surgeons have a variety of procedures, both non-surgical and surgical, at their
disposal to produce excellent cosmetic results in the appropriately selected
patient: temporary fillers, micro-fat grafts, blepharoplasties, and combinations of procedures.. Each
has benefits and drawbacks and depends on desired outcome and individual
anatomy.

In a patient with your inherited anatomy, a
blepharoplasty will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume
to tell you what to do without seeing photos and 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