Undereye bags in my 20s. How can I get rid of them? (Photos)

The high point of the bag can be matched to the local tissue by injecting filler around it..... THEORETICALLY.  In practice, it's harder than you might think.  The problem is that the bag is very dynamically positional.  Tilt your chin down and look at them.  They are worse.  Tilt your head back and look "down your nose" at them.  They aren't even there.  So with such a dynamic problem, how will a static injection be just right - all the time?  But 20 is too young for bags and too young for major surgery.  IF they are really bad and you are really bummed about it, a little fat reduction trans-conjuctivally might be the ticket.

  Non surgical options such as treatment of the under eye hollows with Restylane should be your first option.  If you are not satisfied, then you could consider conservative transconjunctival lower lid surgery.

Hi

Well you have two options.  One is to take the fat prominence of the lower lid and translocate (shift) it into the hollow below - this will improve contour and appearance.  The non-surgical option is filler.  I prefer Restylane. 

Best

 

Dr. Massry

I would recommend a Trans-Conjunctival blepharoplasty. This procedure would remove any excess fat under the eye and does not require any sutures.

Dear Suz1,

I believe a good place to start with a hyaluronic acid filler like Restylane for that area.  It will hide the bags and give a nice result that should last 18-24 months.  I would hold off on surgery until you are a little older and see how things come together down the road.

Best,

Nima Shemirani

Dear Suz1

thank you for your question.  'Under eye bags' are common and can arise from the genetics in your family or with age. They can be treated with surgery or with injections.  Injections are done with Restylane- placed on the deep layer- this will eliminate the hollow under the eye, take away the tired appearance and give a nice shape to your cheek bone.  Surgery can be done through a variety of techniques- they would involve some removal of the puffing fat and some micro fat grafting to buiid up the shape of the cheek bone and eliminate the hollow under the eyes.

With Warm Regards

Trevor M Born MD

Dear Suz1

I understand how you feel about the lower eyelids.  It is important to understand the structure described as the first bag is a normal eyelid structure of the orbicularis oculi.  It is normal and the groove just below it is the lower eyelid crease.  This is a normal structure and removing the lower eyelid crease does not look right.  Below this is fullness from a small amount of so-called herniated orbital fat.  This fat can be addressed with a surgery called an arcus marginalis release which is performed from behind the lower eyelid with no skin scar.  The fat that constitutes the full area is rotated as a living graft into the top of the cheek.  This can be done under local anesthesia in the office for many patients or in the surgery center under a little intravenous sedation.  My website has examples of this type of surgery.  There is also an excellent alternative to this surgery which is to fill the circle with Restylane.  This type of treatment involves an office visit and might need an adjustment afterward.  This type of treatment will last well over a year, and possibly longer.

The eye sockets have a cushion of fat for your eyeballs called peri-orbital fat which is held in place by an orbital septum in your eyelids. Typically age weakens this septum and allows the fat to fall into the lower lids. The shadowing is due to a hollow area below the eyelid, the tear trough. You can seek treatment to build up this hollow area to bring this skin into the light stopping the shadow formation. This can be accomplished with fillers such as Radiesse. Radiesse will last in between 12 to 18 months depending on your natural level of collagen.

Dear Suz1,

What you are seeing in your lower eyelids is often seen in Asian eyelids with herniated fat pockets.  You have a physicially noticable orbicularis muscle just below your eyelashes. Addressing this is difficult and I would more focus on the larger herniation below which is the orbital fat that you are seeing.  Given your age and texture of your skin,  you may very well be a good candidate for a hyaluronic acid filler to help treat this area.  My filler of choice here is Restylane. It is safe, well tolerated, and reversible if the results do not resort to be optimal. However, it needs to be placed in the correct depth so that it won't be visible or palpable given your apparent thin skin.   You need to make sure you see a physician that has alot of experience treating lower eyelids with fillers.  A blepharoplasty is also another option, one that is obviously more long lasting. 

The photos really show 2 sets of bags in each lower eyelid. The first is a muscle bag just below the eyelashes. The second is just above the eyelid cheek junction and is a fat bag. At this stage I would not recommend addressing the upper muscle bag because in my opinion that would require surgery and has a high recurrence rate. For the lower bags your best option is probably a filler injection. You should also have your eyesight checked to make sure that unconscious squinting is not contributing to this.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.