50 YO Female Looking for solutions for tear troughs/eye bags. (photos)

I have had black under eye circles since childhood, but have developed deepened tear troughs and herniated fat pads/bags in the last 8-10 years. I would ideally like a non-surgical/less invasive approach first (fillers?). Also, I am looking for Seattle area providers who specialize in this and have a strong track record and similar case studies. Thanks!

Doctor Answers 5

Fat repositioning blepharoplasty vs fillers

Dear BethSu0602

Your have lower eyelid fat prolapse (bag) that exacerbates your tear trough.  Both surgery and fillers can address your problem, though with differences in what they can achieve and how long the effects can last.

Fillers are often an excellent choice to fill in the tear troughs for patients with more subtle fat prolapse. However, with more significant fat prolapse, higher volume of product will be needed that sometimes makes the results less natural.  I would recommend that you see a surgeon with expertise in both surgical and filler techniques so that they can discuss the pros and cons of both alternatives, and recommend what may be best for your.

Contrary to what some self promoting "experts on this site indicate, Seattle has plenty of surgeons that can provide you with an excellent result both surgically and with fillers. 

Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Fillers For Tear Trough/bags

There are many ways to approach the bags in your lower lid. Fillers may be a potential option; however, an in person consult with a trained injector is necessary. Know that bruising and swelling from this procedure are incredibly common and should be expected. Do not plan on any major events for approximately three weeks after your injection. Find out if your injector can use a cannula as this may limit the amount of bruising. 

Anthony J. Wilson, MD
Portsmouth Physician
5.0 out of 5 stars 13 reviews

Facial Sculpting -- Fillers, Sculptra, Fat, Implants ; Skin Tightening with Ultherapy and Thermage

I suggest you see an expert for treatments in the area of volume and sagging to prevent aging process.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Tear Troughs and Lower Lid Bags: A Non-Surgical Approach

This is a great question, because a lot of women and some men are asking the same thing.  Fillers usually work very well.  There are a number of fillers available.  The short term fillers, like Juvederm and Restylane are OK but do not give the best definition because they have to be placed in the deep tissue to avoid a problem they can cause, a blue hue called a Tyndall effect.  The one and done filler or long term filler Bellafill works wonderfully for below the eyes to correct exactly what you are wanting to deal with, lower eyelid bags and tear troughs.

I have added a video on filler for you and a link to an number of lower eyelid correction before and after photos.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 62 reviews


Recontouring the eyelid cheek junction with hyaluronic acid gel filler can smoothen the volume changes and delay the need for surgery. Dr Shu Hong Chang is an experienced oculofacial plastic surgeon based in Seattle. 

Costas Papageorgiou, MD, FACS
London Facial Plastic Surgeon
5.0 out of 5 stars 18 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.