Late 30s female with under eye bags. What is the best option for me? I am open to surgical or nonsurgical procedures (Photo)

I am more interested in the inside the eyelid procedure. What is the difference between that and a traditional eye bag surgery?

Doctor Answers 8

Hidden Incision Lower Blepharoplasty

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Hi Lfppgirl, thank you for your question!
Based on your photo you do appear to be a good candidate for a lower blepharoplasty! A lower blepharoplasty involves an incision behind the eyelid to remove the existing fat bag, replacing hollowness in the tear trough below where the bag sat and then ironing out the fine lines and wrinkles using a medium depth laser resurfacing. 
There are 2 major differences between the results of a blepharoplasty where the incision is placed behind the eyelid versus an external incision along the lower lashes.  The first difference, is obviously a visible incision line. When the incision is created behind the eyelid, the patient is not left with any visible incision lines to heal from. Incision lines remain pink and stiff for about 3 months following surgery, so you may feel it takes longer to be socially presentable following a lower blepharoplasty with an external incision. The other benefit to the incision behind the lid, is you have a much lower risk of eyelid drooping because you are not cutting through muscle when removing the bag from behind the eyelid. 
Another important step of lower blepharoplasty is the fat transfer to the hollow tear trough. Once the fat bag is removed, most people tend to look deflated. Transferring nice smooth fat from the abdomen to the tear trough gives patients the most youthful under eye appearance without leaving patients looking gaunt.
Finally, the medium depth laser resurfacing helps to smooth out any wrinkles that may become apparent after removing the fat bag. We include the laser resurfacing as a complimentary portion of this procedure as it helps to provide the overall best result for our patients.
I hope this information helps! Please let me know if you have any other questions or concerns!

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Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews

Lower Eyelid Blepharoplasty

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Looking at your photos I would suggest a lower eyelid blepharoplasty.  This would remove the bags and also correct the wrinkles and excess skin.  I would suggest using the subcillary technique.  This would allow for a better result than a trans-conjunctival (TC) approach.  Of course, a comprehensive examination would be the first step.

Jessica Lattman, MD
New York Oculoplastic Surgeon
4.7 out of 5 stars 28 reviews

Lower lid TC bleph

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From these photos, it looks like you would get a homerun result with an upper and lower lid TC blepharoplasty. This procedure would make you look more rested and open up your eye. 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. See a board certified surgeon in your area with an expertise in aesthetic surgery for more information. Good luck with your procedure!

Dean Vistnes, M.D.
Vistnes Plastic Surgery
San Francisco Bay Area

#realself #drdeanvistnes #blepharoplasty

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 51 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

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The eyes are best treated with a combination approach of fillers, lasers, microneedling/PRP for improvement. Ultherapy/thermage, venus legacy all do well for swelling or puffiness. I would suggest consulting an expert. If surgery is an option they will recommend. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews


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Removing fat from behind the lid is reasonable because there is not a lot of excess skin.  But a careful exam is needed to determine if you have any fixable deformities when you animate that would alter the options.

Luis Villar, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 11 reviews

Options for under eye bags

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The best, long term treatment option with natural results. is transconjunctival lower blepharoplasty with fat repositioning. A non-surgical alternative would be filler injection. See link and video below.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

I think you would benefit from eyelid surgery.

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In my office, I would encourage you to have a transconjunctival lower blepharoplasty with a lower eyelid chemical peel.  Seek several opinions before deciding on a surgeon.  I recommend finding an aesthetically oriented oculoplastic surgeon for this work.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower lid bags

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You have some significant hollowing of the lower lids.  The easiest thing to improve this is with some filler such as Restylane.  For surgery:  you can do a transconjunctival approach to work on the fat.  I prefer to move the fat down into the area that is hollow to maintain the volume and make it look smooth. Some surgeons like to take the fat out, which can lead to further hollowing and the need for fillers later on.  But both of these are done from the inside of the lid.  

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 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.