Under-eye bags are caused by fat that is herniating out from under the eyes. This process occurs secondary to a loosening of the tissue that normally holds the fat back in the orbit creating a hammock-like effect. This is common in older patients but can occur in younger patients as well. Your pictures are a good example of this bulging. In younger patients with good quality skin and mild to moderate under-eye bags, a hyaluronic acid filler such as Juvederm or Restylane can help camouflage the bulging fat and improve the contour in this area.
Your pictures however, also show 1) a loss of midface (below the eyes) volume due to loss and decent of fat in this area and 2) poor thin skin quality due to aging and sun damage. In patients with these complicating factors, treatment will require a significant volume of filler to overcome the loss of midface volume. In addition, there is a real risk of creating another bulge beneath the bulging fat that will make for a disappointing overall result.
I steer patients with pictures similar to yours towards surgery. A lower lid lift with fat redraping, with or without midface fat grafting (depending on the overall facial appearance) will smooth out the contour and restore youthful volume to the midface. The cost would be comparable to the amount spent on filler and have the advantage of fixing the problem and not just camouflaging it for a short time. See the link below for more info.A detailed examination will help delineate the best option. A formal consultation with a plastic surgeon is the next best step.
Lower Eye Bags
Thank you for your question and photos. After reviewing your pictures I would suggest a lower eyelid blepharopalsty. Filler is an excellent choice for younger patients who have more subtle changes in the lower lids. I would suggest a complete examination with an oculplastic surgeon to discuss your treatment goals. A surgical approach would be the best option for you. For patients that are good candidates for filler, in my experience, Restylane is the best choice for the eye area.
Lower Lid Blepharoplasty
Great question. The “puffs” you are noticing are due to herniated
fat pads, which are very common and often occur as we age. These bags can be
temporarily disguised with a hyaluronic acid filler called Restylane. I have
had excellent results using the innovative microcannula technique, which
reduces risk of swelling, minimizes pain, and is essentially bruise-less. Using
this technique, filler can be injected evenly requiring only one needle stick
on each side. Although filler can be a great temporizing measure to camouflage
the under eye bags, I would be remiss if I didn’t also recommend surgery. Based
on the photos you have provided; you are an excellent candidate for a lower
blepharoplasty with fat transposition. This procedure offers a more permanent
solution to the problem, whereas filler needs to be repeated each year. I
recommend consulting with a board-certified plastic surgeon who can evaluate
you in person and further discuss these treatment options. Best of luck.
Under eye fat
You have some significant fat prolapse, and a deep tear trough and extensive skin aging. Restylane would be the filler or choice for the tear trough. While this will help, you would be a good candidate for lower lid blepharoplasty with fat repositioning and some laser resurfacing.