Eye bags, surgery or less invasive? (Photo)

I just want to minimize my bags, I don't mind returning for treatments after many months. I talked to a Dr. today, who laid out a 9 step surgery... is it really necessary if I want to see improvement?

Doctor Answers 9

I think you need eyelid surgery.

If you were against having surgery, fillers can make a difference but you need enough fillers that the cost might be like having a surgery.  A chemical peel also has the power to flatten the bulging fat.  I recommend seeing more doctors.  I would encourage you to avoid transcutaneous lower eyelid surgery and look for a surgeon who offers transconjunctival ( behind the eyelid surgery).  This is typically performed by facial plastic and oculofacial surgeons. It should not be so complicated. 


Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Eyelid Surgery or Injectables?

Sometimes it is difficult to choose between undergoing cosmetic lower eyelid surgery or receiving some type of injection along the lower eyelid regions.  Women (and men) who have just a little lower eyelid fullness and aren't sure about undergoing surgery, sometimes injection of some type of filler can provide a nice benefit.  Depending on exactly what is injected, the filler may last for many months or could potentially even be permanent.  When there is obvious fullness, lower eyelid surgery will usually provide a better result.  

Visiting with a surgeon experienced in lower eyelid surgery will usually provide the answers a person needs regarding what is likely to work best.  The photos you've provided are really interesting to me.  When I do lower eyelid surgery I place marks on the patients immediately before surgery.  I actually have them do what you've shown in your second picture:  look up.  When they look up it helps me see a pocket of fat out toward the side that might otherwise be missed during surgery.  Looking at your pictures I can actually see that little bulge out toward the side in the picture where you're looking up.  Your photos, to me, suggest lower eyelid surgery would likely provide a much better result than doing injectables.  Visit with another surgeon if you are unsure about what your first surgeon told you.  It's fair to ask questions on RealSelf, but ultimately only someone who actually examines you and knows all of the details of your medical history can provide you with answers that are likely to work best for you.

Kelly R. Kunkel, MD
Fort Worth Plastic Surgeon
4.8 out of 5 stars 24 reviews

Permanent Solution To Fix Eye Bags - And Recovery Time

Filler can be effective -- but only in the right patient. For you, with your anatomical configuration, filler would very possibly be a waste of money and make you look puffier. The significant amount of fat that you have under your eyes could be surgically removed, making you look less tired (or not tired at all!). This is called a "blepharoplasty," or a "bleph."  The recovery is not as involved as many patients think. In my practice, I like to make the incision in the inner part of the lower eye, so you don't ever see a scar. In a week or less, you can be back at work. Please have a consultation with a board certified plastic surgeon who has decades of experience on the eyes and face (not just the body). Do your research well, and read reviews and look at the surgeon's before-and-after photos.

You might also like...

Non-Invasive Versus Surgery

Fillers, lasers, and microneedling/PRP can improve under eye bags. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Eye bag improvement

Your lower lid bags are due to a combination of 1.) forward relaxation of eye socket fat pads, 2. sagging of the cheek fat pads, and 3. loss of cheek fat pad volume. You could reduce the appearance of the bags with dermal fillers or fat transfer in the area just below the bag, which we refer to as the 'tear trough' or 'nasojugal groove.' The best solution to reduce the fat bags is a gentle incision through the inside of the eyelid to sculpt the fat pockets. I don't consider this a nine step procedure. 

Daniel Lensink, MD
Redding Oculoplastic Surgeon
5.0 out of 5 stars 5 reviews

Lower lid blepharoplasty

You have some pretty significant lower lid fat prolapse.  HA filler could help to mask it a little.  But with this amount of fat you would do best with a lower lid trans-conjunctival fat repositioning.  In this surgery the fat is moved down into the tear trough and helps to smooth out the contour.  Moving the fat instead of excising it will prevent post-op hollowing.   

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 25 reviews

Under eye area

Are you considering surgery or do you prefer a non surgical approach?  For surgery you can consider a lower blepharoplasty which will help to contour the under eye area.  For a non surgical approach you have various tools available, which when used in combination can give a nice improvement.  You may consider fillers and laser treatments to improve the area.  Unlike surgery, these are not permanent changes and will need touch ups routinely.  I'm not sure what the 9 step surgery is that the surgeon you spoke to about.

Camille Cash, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews

Lower Lid Surgery

You look to be a good candidate for lower eyelid surgery.  Depending on your skin quality, this may be done from inside the lid.  An open approach would allow tightening of the muscle and skin removal depending on the quality and laxity of the lower eyelid skin.  

Surgery best but you have options

Your major problem (based on limited photos) appears to be the pushing out of the fat from around your eye into your lower lids.  this can be somewhat camouflaged by filler injections which may be worthwhile to attempt if you are opposed to surgery.  However, the most powerful procedure will be the removal and/or repositioning of the fat causing the problem during surgery.

Colin Pero, MD
Dallas Facial Plastic Surgeon
4.6 out of 5 stars 13 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.