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

Question

My bags are puffy and dark - but the puffiness is what bothers me most. I look tired when I'm not tired. What type of blepharoplasty is recommended at my age? I doubt fat transfer is the answer for me.

Harold J. Kaplan, MD · Answer

There are non-surgical options but at your young age surgical blepharoplasty will do very well and last for many years(15-20) and truly resolve the problem. You appear to have enough skin and muscle laxity that a skin incision is probably necessary but that heals rapidly.

Timothy R. Miller, MD · Answer

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.

Michael I. Echavez, MD · Answer

In general, there are two methods to help with hereditary under eye bags.  The non-surgical option would be using a filler, like Restylane, to inject under the bags to camouflage them.  This is a fairly simple procedure but it would be temporary.  The other option would be to address the excess fat surgically.  This would give a much longer lasting result and deal with the issue directly.

Laxmeesh Mike Nayak, MD · Answer

Your hereditary under eye bags would be very well treated with a transconjuctival lower blepharoplasty. You could expect a 90% improvement, with excellent durability.

Jason J. Hall, MD, FACS · Answer

Your choice of treatment for your eye bags depends on a number of factors - your anatomy, cost, down-time, and tolerance for risk to name a few.  In young patients with under eye bags, the culprit is usually under-developed cheekbones, which normally give support to the lower eyelid and "hide" the fat that is present in everyone.  Based on your pictures, you would likely get a good result by augmenting your cheekbones with a soft-tissue filler and adding a small amount to the "tear trough" area.  If you desire a more permanent (surgical) solution, repositioning the fat of your lower eyelids would correct the bags and give you a more youthful, refreshed appearance (likely with the addition of some fat grafting in this area, as well).See a board-certified surgeon to discuss your options - you need to have a detailed examination to help guide you to the solution that works best for you.

Joseph L. Grzeskiewicz, MD, FACS · Answer

You look like a young lady, although you didn't really give us your age.  Typically bags under the eyes in younger people, especially when they have been there their whole lives, have as much to do with their anatomy as they do with loss of tone or volume in tissues around the eyes, which is usually the cause of under eye bags in our older patients.  Thus, it follows that anyone attempting to correct this for you must perform a very detailed exam on your orbital area, and understand what the anatomic cause of the problem is.  A very important example of this has to do with the fat around the eyes.  Many times people will misunderstand the difference between protruding fat and excess fat, and when they do a blepharoplasty they will remove protruding fat thinking that it is excess.  This creates hollowing and loss of volume in the orbit, because you really needed the fat, it just needed to be repositioned or camouflaged.  Thus things like transconjunctival blepharoplasty or even fat transfer may actually have a role in your treatment; it just all depends upon what your eyelids look like on exam.  Treatment plans also depend upon your personal preferences too.  Things like tolerance for surgery versus non-surgical options, recovery time, budget, and the like will all factor in.  Depending upon where you are with some of those considerations, you may not want or be a good candidate for surgery at all, and a non-surgical or minimally invasive plan like filler injection or fat transfer may be better for you, even though you might have some issues like tissue laxity that would do better with surgery.  The best thing that you can do is schedule a consultation with a board certified plastic surgeon, facial plastic surgeon, or occuloplastic surgeon who has experience with all forms of treatment of the eyelids, surgical and non-surgical, so that you can get a detailed assessment of your eyelids as well as your personal goals, and you can be presented with all of the available options for treatment.  Good luck.

Robert Singer, MD · Answer

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

Sanaz Harirchian, MD · Answer

Hi jessieinSF. The best treatment for lower eyelid puffiness & darkness depends on the underlying cause and your anatomy. If the puffiness is due to fat protrusion, then surgery is typically the best long term solution. Whether the fat during surgery is removed or repositioned depends on your underlying anatomy. If the dark areas are due to hollowing from volume loss, then volume restoration (with fillers or fat) is helpful. Lax undereye skin can be treated with either very conservative removal (skin pinch) during surgery, and/or with laser resurfacing. An in person consultation is really needed to evaluate all of these factors to determine the best treatment for your situation. Good luck. Best, Dr H

Amiya Prasad, MD - Account Suspended · Answer

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&trade; 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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M. Dean Vistnes, MD - Account Suspended · Answer

From these photos, it looks like you would get a homerun result with a lower lid a TC blepharoplasty. In my experience the most important thing in assuring a quick recovery from blepharoplasty is minimizing bruising and swelling. Bruising is much easier to prevent that to get rid of. I have all my patients ice as much as possible from the time they get home until they go to sleep that first night. And I instruct them to not recline any more than 45 degrees until they go to sleep that night. And stay away from salt. Patients who follow these instructions generally heal very quickly with little or minimal bruising or swelling. Good luck, Dean Vistnes.

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

Answers (10)

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