What is the Best Treatment for Under Eye Bags? (photo)

I have had these under eye bags my whole life and I don't like the way they make me look. I am tired of being mistaken for looking sad or sleepy when I'm not. I have tried every remedy in the book and they had no effect on me whatsoever. Makeup does nothing to conceal the shape of the bags as well as the puffs. I really want to know what my options are as far as removing them and which option is best for me based on my picture. Thanks!

Doctor Answers 8

Bags under eye must go

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You will look more attractive with no bags.   The fat must NOT be removed.  The fat must be transslocated into the orbital rim area.  Look at your eyes carefully.  You do have bags but you also have hollowness of the orbit.  This is a demarcation zone or malar groove.  The hollowness occurs with fat loss of aging and is normal aging.  In your case eye bags have been exposed.  These bags are simple protrusion of fat that is around the globe of the eye.  The fat has herniated through the septum orbitale.  It must be saved,  Too much fat is removed all too often and I see many patients that need fat replaced because fat was removed during a blephroplasty.    So go to an ABPS  surgeon or two and seek opinions.   My Best,  Dr C

Correction of eyelid bags with surgery in Los Angeles

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I advocate a fat transposition blepharoplasty for the lower eyelids which allows for correction of the eyelid bags and also filling in of the tear trough. Raffy Karamanoukian, Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Options for Lower eyelid bag treatment

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Generally, there are a few options to improve the appearance of the lower eyelids, eye bags, or dark circles. First option includes basic skin care, tretinoin, and/or chemical peels. This nonsurgical method helps improve the skin quality, reduce pigmentary changes, and improves overall appearance of the lower eyelid & cheek areas.

Second more advanced option is an injectable filler or fat to plump up the area. Fillers are made of material that is slowly removed over time. Hyaluronic acid facial fillers such as Restylane or Belotero have been used to help smooth this area. Facial fillers treatment is performed in the office vial local anesthesia and with long-lasting results.

The last option, and also the most aggressive, is eyelid plastic surgery. Cosmetic surgery of the lower eyelid may remove or reposition fat in the eye bag area, and possible remove some sagging skin. Plastic surgeons typically don't recommend cosmetic eyelid surgery in young patients as the first option. However, each patient is unique and circumstances may vary. Age alone is not a determining factor if a person is a cosmetic surgery candidate.

Only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Photos are not ideal

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The photos you have provided, though helpful, are not ideal:  It is difficult to assess whether the self photos are taken with you chin tilted up or down.

From the photos, it seems that you have lower lid fat prolapse, which likely is a hereditary issue. Furthermore, you also have lower eyelid retraction. This means the lower eyelid is too low and allows the white of the eye to be seen below your cornea [scleral show].

It would be valuable for us to also see your cheek volume/projection. An underprojected cheek exacerbates the issues I mentioned above.

Fillers may in fact be a good option for you, but it may be that lower blepharoplasty [fat transposition] with lid retraction repair and possible cheek fat grafting may give you a better overall result that is much more long lasting.

You would benefit from a consultation with an experienced Oculoplastics Surgeon. You can find one close to you using the link I have provided below.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Correcting lower eyelid bags

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Thanks for your question. It would be very important that you have a thorough evaluation by a qualified surgeon such as an Oculoplastic specialist before committing to a procedure.  Treatment with hyaluronic acid fillers is a potential means of camouflaging the appearance of the under eye puffiness.  More invasive but potentially more long lasting would be to undergo lower lid surgery.  The surgeon needs to pay attention to your eyeild position (which appears somewhat retracted in your photo) and to the projection of your eye and cheek region.  Based on that, a decision can be made as to whether you would be a good candidate for lower lid fat transposition surgery.  I hope this provides some guidance.

Paul T. Stallman, MD
San Luis Obispo Oculoplastic Surgeon

They can be treated with surgery, but there are some considerations for people with a darker skin type

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Under eye bags represent fat pockets called lower eyelid fat prolapse. This means that the fat that is normally around the eye pushes forward and creates a bulge. This is usually a genetic trait that can happen as early as a teen and can happen throughout the lifetime of an individual.

Under eye bags is one of the most common procedures in my practice. Years ago, the approach to address this was the transcutaneous approach in which the incision is done on the outside. However, I learned that it is important to customize procedures according to the patient’s ethnicity and skin type. The transcutaneous approach usually leaves a mark especially on people who have dark skin.

In my practice, I usually perform transconjunctival blepharoplasty. This procedure addresses the fat pockets from the inside of the eyelid. By this way, I am able to reposition and remove the fat without any incision on the outside. I often combine this procedure with a material called platelet-rich plasma. This is drawn from your own blood and is spun down to concentrate the platelets. Platelets help in the healing process of the body and they also have growth factors that improve skin quality. All of these procedures are done under local anesthesia with LITE™ IV sedation. This means patients are sparred from having general anesthesia and are able to recover quickly after the surgery. In fact, they are able to go back to work usually in less than a week.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Dangerous bulging eyes

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When a patient has bulging eyes (proptotic) the risk of having ectropion (scar that pulls the lower lid down) or scleral show (lower half of the eye white showing) is high. You should try  a filler under the bags to hide the bags. If that does not work well then may be a conservative blepharoplasty (removal of fat only, no skin excision)

Dr. J
Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

There is no "best" treatment.

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All treatments have risk and benefits associated with them.  This includes eyelid surgery and filler services.  It is your task together with your cosmetic surgeon to decide what makes sense for you.  Personal preference often is the most important factor.  You would do well with lower eyelid surgery or under eye filling with a hyaluronic acid filler like Restylane.  You may decide that you don't want a temporary filler.  Or you may have a preference for avoid surgery if at all possible.  I recommend focusing on finding the right surgeon and having a personal consultation.  From there, you and your surgeon can determine what your personal best option is based on your concerns, physical needs, and personal preferences.

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