S.O.S - Under Eye Bags - Surgery or Filler?

Had them most of my life, only in my thirties are they more obvious. The only thing that ever lessened them was a good sweaty work out. Now that doesn't even work. I can't understand how filler would be good option since under eye bags tend to increase/decrease thru-out the day??? My skin is thin, very pale, and I have a boney face. Per your experience with similar patients what r options/potential risks? Advice much appreciated! Eye pix below looking down/up/sideways etc. Thank you!!

Doctor Answers 6

A note of caution here.

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You have very thin eyelid skin.  Without a personal examination it is not possible to predict how you will do with lower eyelid fillers.  They can be very problematic in individuals with ultrathin lower eyelids.  Sometimes, the only way to know how you will do is to actually do the treatment.  Unfortunately you need a fairly large filler treatment to make a difference.  I thing you better know that you are seeing one of the best lower eyelid injectors because a well meaning individual with good credentials can make a mess of this.  Please do your home work and find someone in your area you are very comfortable with and can see frequently because thin eyelids like this often require a number of treatment adjustments.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Treatment lower lid bags with surgery or filler

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Thank you for providing photos.  From you pictures it looks like you have excess lower eyelid fat.  I think the best treatment for you is likely to be a transconjunctival blepharoplasty (from the inside of the eyelid).  With that surgery there is no skin incision and no stitches are needed.

You may also benefit, at some point from some facial fillers. However I would start with a conservative removal of your excess lower eyelid fat with surgery.

Marc Cohen, MD
Philadelphia Oculoplastic Surgeon
4.8 out of 5 stars 26 reviews

Eyebags surgery, eyebags filler, risk

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Filler will only partially correct large eyelid bags. 

Carefully and conservatively injected Restylane or Radiesse below the lids will camouflage the bags to decrease their visibility.  Sculptra or fat injected into the cheeks is another good option to fill out the hollows below the lids and the cheeks.

Lower Blepharoplasty with eyelid fat repositioning is the most long lasting option which corrects both the bags and the hollows below the lids.

Please consult in person with an experienced Board Certified Plastic Surgeon prior to making any treatment decisions

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon

Treatment of tear troughs and lower eyelid bags

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As you may have already realized if you ask 10 different surgeons you will get 10 different answers. The first photo you posted is out of focus but it appears that you have visible lower eyelid fat protrusion (bags) when looking straight forward, down or up. It is not clear that you have excess lower eyelid skin though. My preferred treatment for that is to surgically suture that protruding fat to the deeper cheek fat and then trim any excess off the superficial surface of that fat. That would diminish the protrusion and minimize the concavity of the lower eyelid-cheek junction. The referenced web page describes this in greater detail.

If you just cut out all of the fat in the lower eyelid bag there is a tendency to end up with a hollowed out skeletonized look. If you use a non-invasive method of destroying this fat there is a greater risk of left vs. right lower eyelid asymmetry.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

A well-performed Injectable Filler treatment may improve the appearance of your lower eyelid bags.

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I read your concern and reviewed the photos you posted.

In my practice, the majority of patients with lower eyelid bags may benefit from an Injectable Filler treatment. Your lower eyelid bags are prominent since you appear to have lower eyelid grooves between your lid bags and your cheeks. Carefully placed filler into your eyelid grooves may improve the appearance of your lower eyelids by allowing the bags to blend into your cheeks.

Be sure your physician is experienced in the delicate art of filling this area before proceeding.

I hope this is helpful for you.

Regards from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Under eye bags best treated with lower eyelid surgery

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The photo, of your eyes, appears to show excess fat bags in all three of the lower eyelid areas.  Lower eyelid surgery (Blepharoplasty) will remove these, I prefer the transconjunctival technique using an incision inside the lower eyelids.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 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.