What are options for under eye bags, circles and wrinkles? (Photo)

I'm almost 40 and tired of looking tired :) I have two little kids so I don't get enough sleep. I do eat really healthy, use sunscreen, and have regular facials. I feel like the last two years I've seem a big change in my skin, eyes the most. Thank you.

Doctor Answers 8

Options for Under the Eyes

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Hi, Ali.
Thank you for your question.

As a father, I can relate to not getting enough sleep! You are also in good company when it comes to your cosmetic concern. Often, my patients start to notice a significant change in their skin around the age of 40, and this often includes thinning of the delicate skin beneath the eyes. Also, you lose fat in this area as you age, so you get a hollow area that creates a dark shadow. The remaining fat often looks like puffiness or "bags," when it's actually just pre-existing fat that appears more pronounced now that the surrounding area is receding.

The good news is that there are many minimally invasive treatment options available to you that can achieve what makeup cannot. I recommend a dermal filler, such as JUVÉDERM® or Restylane®, to restore the insulating fat layer beneath the eyes, reducing the appearance of bags, shadows, and circles under the eyes. Sometimes enhancing the cheek projection with these fillers also helps the appearance of the under-eye area. This type of facial sculpting is truly an art form, so be sure to seek a board-certified facial plastic surgeon. You can view my photo gallery and watch this video to see the difference dermafillers can make.

Good luck.

Bay Area Facial Plastic Surgeon
4.7 out of 5 stars 156 reviews

Eye Bag Treatment Options

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Thank you for your photo and the question. It's not just sleep -- this is, unfortunately, a fact of aging. For most people, the first signs appear in the eyelids. This is often a hollow appearance, dark circles, or eye bags. In younger patients, this is generally fillers. Soft tissue fillers, made of a naturally-occurring material that is found in cartilage and connective tissue, can be injected to even out the surface of the lower eyelid and upper cheek. This is done in the office and takes only a few minutes. More permanent solutions, like a lower eyelid lift, are also a great option but require some downtime.

Options for Improving the Eye Bag

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One option is surgical excision of herniated fat of the lower eyelids and then re-draping of the skin. Alternately, you can use fractional laser on the lower eyelids to tighten the skin. The laser would also fine tune the texture of the skin and can be used beyond the extent of the lower lids. Topical creams aimed at the eyelid bags are not effective alone. You need to use the creams in conjunction with surgery to create a nice effective. At age 40, you are in the realm of surgery to correct the aging orbit. This type of cosmetic eye surgery is quick and easy. You can also correct tear trough deformity with Structural Fat Grafting.

Michael Stefan, MD
Philadelphia Plastic Surgeon

Options for improving eye bags

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There are many options for improving eye bags. There are pros and cons of course to each . Fillers can be used to temporarily camouflage the lower eyelid irregularities and can work quite well. Surgical options would include lower blepharoplasty through a skin incision or from inside the eyelid. I prefer to go through the inside of the eyelid, free the fat and slide it into the groove to fill it. This gives a long term improvement in the fat bulge and the under eye groove at the same time without having a visible incision.

Consult with a surgeon who can perform all the options to get an unbiased opinion

good luck

Thomas Buonassisi, MD
Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 114 reviews

Options for treatment of lower lids

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There are several types of procedures that can improve your lower lids. You can consider skin resurfacing to tighten the skin. You can use fillers to smooth things out. And you can have surgery in which the lower lid fat pads are either removed or repositioned.

Suzanne Kim Doud Galli, MD, PhD, FACS
Washington Facial Plastic Surgeon

What are options for under eye bags, circles and wrinkles?

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Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary fillers, micro-fat grafts, and blepharoplasties. There is no one best procedure. Each has benefits and drawbacks.

Following the advice of anyone who would presume to tell you exactly what to do based on a limited 2 dimensional photo without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) through Smart Beauty Guide. You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Blepharoplasty or fillers

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The two main options you have are fillers or lower blepharoplasty.  I typically use Belotero to fill in the tear troughs, but Restylane is also a good option.  These are both made of hyaluronic acid and are very silky.  Alternatively, you may do well with a blepharoplasty and fat repositioning.  An in person exam would be necessary to determine what the best option for you would be.

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Fillers or surgery can provide you help.

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Restylane can be used to fill in the under eye tear trough.  The service is a little fussy but it is an office services that is done by injecting filler-no surgery.  The results can be as good or better than surgery.  You need a fussy injector and typically one or two follow up visits may be needed to adjust the product.  Longevity is well over a year.  It is also important to get enough product to smooth the hollow between the lower eyelid and the cheek.

Surgery is generally transconjunctival arcus maginalis release surgery.  It is important to assess the skin quality also and decide if something needs to be does to address this as well.  Surgery is performed on an outpatient basis under IV sedation.  It is generally about two weeks before people stop asking what just happened to you.

It is common now to perform surgery and also fillers.  I would encourage you to see if fillers will work for you saving you the need for a surgical procedure for hopefully quite some time.  

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.