Transconjuntival Blepharoplasty or Filler? (photo)

Hi, I am 22 years old, I have eye bags under my eyes even though I get enough sleep. I've had them since I was 12 both of my parents have them as well. Is it genetics? Which procedure will be most appropriate to remove / conceal them? Will I get hollow eyes after the procedure? Is there any chance of "failure" in the procedure that makes the eyes look worse? How long is the procedure and how long does it take to recuperate? Thank you very much for your help!

Doctor Answers 5

Surgical versus Non-Surgical Treatments

This kind of under eye contour found in such a young person is most likely genetic. It is important to have your eyes evaluated by an experienced and certified plastic or oculoplastic surgeon in person to determine the best course of treatment. While "bulges" or "bags" under the eyes are caused by excess fat that can be removed with a lower eyelidplasty, in someone so young, a non-surgical approach may be a better place to start. Fillers such as Restylane or Belotero, two hyaluronic acid fillers that are best for more superficial injections in thin skinned areas such as under the eyes or around the lips, are good options. I think it would be best to try the non-surgical option of fillers to try to camouflage the bags, and then move on to consider surgical options if you are still dissatisfied.

New York Plastic Surgeon
5.0 out of 5 stars 10 reviews

Bags are Fat Pockets

It appears that the "bags" under the eyes are actually fat pockets and below them there is a shadow reflecting the bone structure. I generally approach this issue by reducing the fat pockets and adding volume in the hollow areas. There is a difference between looking at photo sand doing a proper examination in person so a specific treatment plan can only be developed after you are seen in person by a qualified specialis

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Under eye bags and options

First it probably is a genetic issue in that you inherit your anatomy from your parents. 

More importantly is how to take care of it. The question is whether the hill (eyelid puffiness) or the valley (nasojugal folds = hollowing due to midface descent) is the more significant issue to address. Sometimes you can do one or the other. Sometimes you need both. 

Your pictures seem to indicate the filler will help significantly but not completely. I would try that first. A half syringe (prepackaged by medicis that way, not split in the office!) of restylane would be the product of choice. You can always do the blepharoplasty (transconjuctival) later if it's not enough. 

Best of luck

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 52 reviews

Blepharoplasty and filler.

You need both probably--better photos would help to deteine this.  Yes these are hereditary. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Filler versus surgery for baggy lower eyelids

Actually both. I think you would benefit from a concervatively done transconjunctival blepharoplasty to remove some fat excess, and from filling the area beneath the fat bags. In my opinion, a combined approach would give you the best results possible.  If not sure, start with filler first and see if you are fully satisfied before going for surgery.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

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