I would like to know what could be done about my under eye area at the young age of 21?

Hi! I seem to have a mix of under eye bags and hollow eyes (please correct me if I am wrong!). I am 21 year of age and I feel as though they make me look a lot older than I am and also very tired. I am the only one in the family to have such prominent eyes under my bags, which I find quite unsettling, especially as I am the youngest in the family. Please may you advise me on non intrusive and intrusive options? Thank you so much. Rhianne.

Doctor Answers 7

Eye

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The bone beneath your eye is retrusive which makes your eye look prominent. That bone could be augmented with an infraorbital rim implant and lessen the apparent projection of your eye.

I would like to know what could be done about my under eye area at the young age of 21?

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Fraxel® light resurfacing is my got to treatment of choice for under eye area. As this is a very innovative technique, please consult a board certified aesthetic dermatologist for a consultation. 

Manjula Jegasothy, MD
Miami Dermatologist

Your two options to treat your eye bags are blending them temporarily with filler, or removing them definitively with surgery

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Thank you for your question. You are 21-years-old and describe you have a combination of under eye bags and hollows. You’ve submitted a single photo on an angle showing your eyes, and it appears you are smiling.

I can certainly give you some guidance about your concerns. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, meaning I first trained in ophthalmology or eye surgery, then specialized in plastic surgery of the eyes and face. I’ve been in practice in Manhattan and Long Island for over 20 years, so I have a lot of experience with your type of concern. It is important you have a sense and understanding of why you have both an under eye bag as well as a hollow.

When I look at your photo, it appears there is an area under your eyes where you have a little bulge of what appears to be orbital fat, which we refer to as lower eyelid fat prolapse. This means the fat normally around your eyes pushed, creating a bulge that appears like a bag or bags under your eyes. The common cause of this is genetics. When we look at someone as young as yourself, it is not necessarily what people assume as age-related, but rather a genetic trait. A lot of patients who come to me in later decades will say, “I’ve had these under eye bags since I was a teenager.”

With your eyes at rest looking forward, you might appreciate more the hollow relative to the under eye bag. The bag creates a mountain effect, while underneath it there is a relative hollow, so it’s like a mountain next to a valley.

It is important to understand your options before you move forward with a procedure and for that matter. With someone with darker skin, who is young, there are basically two options for treatment. The more definitive option to address the lower eyelid fat prolapse by doing a procedure called a transconjunctival blepharoplasty. What that means is fat pockets that have pushed forward is addressed from behind the eyelid, so there is no incision in the outside. Although it is a surgical procedure, it’s considered, in experienced hands, to be a relatively minimally invasive surgical procedure. It is still working around the eye, but it is addressing the underlying problem directly. Indirectly, you can have a filler placed in the relative hollow under the eyes. The strategy is to improve the hollow by filling it with a hyaluronic acid filler such as Restylane. The techniques of doing this vary from doctor to doctor, but in our practice, I try to do this with minimal trauma using blunt cannulas to minimize bruising and swelling.

It is important to understand the longevity of the filler approach. Fillers under the eyes can last anywhere from 6 months to several years. There may be a benefit especially if you have a mild amount of fat prolapse. You have 2 possible options, and the third option doing nothing and waiting to do something. With the surgical option and the non-surgical option, you can explore what appeals most to you based on proper examination, and also what is financially and logistically feasible for you, and then move forward.

I suggest you meet with qualified and experienced cosmetic surgeons, and I stress the word surgeons because a doctor with a lot of experience with under eye bags will offer you both a surgical and non-surgical option, as opposed to the doctor who doesn’t do this type of surgery who will push you towards a non-surgical option only. It is unfortunately the bias of physicians to recommend only what they are able to offer you. Someone who can do everything will be less biased, depending on their personality of course.  Meet with a doctor you feel comfortable with and explore these options, then take it from there. I hope that was helpful, I wish you the best of luck and thank you for your question.

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 78 reviews

Dark Circles, Eyelid Wrinkles/Bags -- Restylane or Belotero, Clear+Brilliant/Fraxel, Eclipse Micropen, Viva/Intensif

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Lasers, microneedling/PRP, fillers and skin care/peels can all help this area. Please see an expert for an evaluation.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 204 reviews

Under eye bags or hollowing

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Dear Patient from Great Britain,

Photos of your eyes looking forward and upward and another with overhead light would be helpful in evaluating your particular condition.

There are individuals who have true hollowing under the eyes at an early age and fillers can help improve this condition.

There are others who have fullness in the lower lids creating hollowing beneath the fullness and they are best addressed surgically.

I hope this was helpful.

Adam Scheiner, MD
Tampa Oculoplastic Surgeon
4.4 out of 5 stars 39 reviews

Eye bags

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I WOULD TRY FILLERS BEFORE GOING IN AND DOING SURGERY , THE DIFFERENCE BETWEEN FAT TRANSFER AND FILLERS ARE FILLER ARE LESS INVASIVE AND CAN LAST 6-9 MONTHS SOMETIMES UP TO A YEAR DEPENDING ON WHICH ONES. FAT TRANSFERS ARE USUALLY SURGICALLY DONE WITH LIPO AND TRANSFERRED TO ANOTHER AREA OF THE BODY. A FAT TRANSFER CAN ALSO BE DONE THROUGH A LOCAL AFTER SURGERY FOR A REPEAT FAT INJECTION. FAT INJECTIONS OR TRANSFERS ARE USUALLY MORE PERMANENT. THIS IS SOMETHING THAT YOU MAY WANT TO SPEAK TO YOUR DOCTOR ABOUT IN A CONSULTATION AND SEE WHAT YOUR OPTIONS ARE.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Young eye bags

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THanks for your question. Unfortunately, there are no photos so it is difficult to really know how to answer your question. The hollow under the eyes could be treated with filler if done well. If the eye bags are pronounced, they can sometimes be (temporarily) reduced with an injection of hyaluronidase. The other treatments for eye bags are a bit more aggressive, such as laser resurfacing or surgical excision. This is usually a family trait but see a cosmetic doctor to have a look at them and help you make a good decision.

Rick Balharry, MD
Calgary Physician

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.