What can be done to smooth out the bags under my eyes? (photos)

Question

I'm wondering what can be done to smooth out the bags under my eyes. And the cost . I heard of a procedure where they use a little needle and just drain it .?

Kenneth D. Steinsapir, MD · Answer

Either you have misunderstood the service you are describing or someone is scamming the public.  There are a number of ways of addressing these types of issues: Fillers, chemical peels and lasers, and lower eyelid surgery.  I am not a fan of lower eyelid fat grafting although some on this forum do advocate this approach.  Ultimately there is not substitute for a personal consultations with a surgeon who is very experienced in periocular aesthetic surgery.  Your potential surgeon should do a very through assessment and take time to explain options, alternative, and likelihood of success, complications, and potential risks.

Harold J. Kaplan, MD · Answer

There is no draining of bags under the eyes. Your photos show laxity of the skin and muscle layers of the lower lid as well as fat pad protrusion which in combination cause bags. I think after you are examined in person the recommendation will be to do lower blepharoplasty as your best and longest-term result.

Sirius K. Yoo, MD · Answer

There are no procedures to use a needle and aspirate the puffiness.  The puffiness is fat prolapsing forward from under your globe (eyeball).  There is fluid (extracellular matrix) between the fat cells, but you would be no more successful aspirating that than you would sticking a needle in a bowl of cream of wheat and trying to suck out the liquid there.  Treatment options include fillers with hyaluronic acids (natural compound already found in your skin and reversible if you don't like the results), micro-fat transfer, and blepharoplasty (eyelid surgery).  I would suggest seeing a well respected facial plastic or general plastic surgeon in your area who can guide you through the pros and cons of each option so that you can make an informed decision if you decide to move forward.  All the best!

Larry S. Nichter, MD, MS, FACS · Answer

An Exam would be required for best advice but a lower lid procdedure and a bit of filler of fat transfer is probably all you will need to look your best. Here is some general information: Of all the features on our faces, our eyes are the most prominent indicators of our mood, energy level, and youth. Sagging, drooping, or tired-looking eyes can make us look older than we really feel. Eyelid surgery, or blepharoplasty, is a plastic surgical procedure designed to improve the message our eyes send to those around us.Patients who would benefit from a blepharoplasty include those who experience:Excessive, sagging, or wrinkled upper or lower eyelid skin.Excess upper eyelid skin that interferes with vision.Loss of your natural upper eyelid creaseIf you have puffy pouches of fat in the upper or lower lids that create a tired or aged appearance.Orbital Rim Show: visibility of the bone under the eye sometimes contributing to a dark ring or shadowing.Normally, everyone has a small amount of fat around the eyes. If the quantity of fat increases or the local tissues stretch and weaken, the fat begins to bulge producing “bags.” Occasionally this bulging is seen in young patients and is an inherited family trait, and not a result of aging. These changes have a profound effect on one’s appearance giving a tired or haggard appearance. An attractive face with these early signs of aging can affect a patient’s self-image, attitude and sense of well-being.

Robert Singer, MD · Answer

Most expert experienced artistic plastic surgeons have a
variety of procedures, both non-surgical and surgical, at their disposal to
produce excellent cosmetic results in the appropriately selected patient:
temporary fillers, micro-fat grafts, blepharoplasties, and combination of procedures.  Each has
benefits and drawbacks and depends on desired outcome and individual anatomy.There are no "needling" procedures that will improve the eyelids.

Following the advice of anyone who would presume
to tell you exactly what to do 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).
You should discuss your concerns with that surgeon in person.Fees
vary depending on the extent of the procedure, location of the surgical
practice, and experience as well as the reputation of the surgeon.

Robert Singer, MD FACS

La Jolla, California

Amiya Prasad, MD - Account Suspended · Answer

I’m a cosmetic oculofacial plastic surgeon and I have a background
training in eye and cosmetic surgery. Eyelid and eye bags surgery is something
I do every day. When puffiness under the eyes is constant and is always puffy, that
puffiness is actually fat and not fluid. We call this condition lower eyelid
fat prolapse. This means that the fat that is behind the eye or surrounds the eye
pushes forward and becomes a hernia. The reason why a lot of people confuse
this with fluid is because allergies, sinus problems and eye rubbing are caused
by fluid and can make eyes look puffy. When you have bags that are always
there, then it's probably not due to fluid.

In our practice, we would typically address your problem by physical
examination and confirm the puffy bags are caused by fat. We perform a
procedure such as a transconjunctival lower eyelid blepharoplasty. This is a
procedure which is performed from the inside of the eyelid to address the fat
pockets. That means resection or removal and repositioning when appropriate. In
addition, we use platelet-rich plasma (PRP) which is derived from your own
blood and helps improve the quality of your skin by generating collagen and
blood supply. It also improves the health of the skin because the eyelids skin
is the thinnest skin in the body, and improving the skin quality is very
beneficial. Sometimes we also do fractional CO2 laser to help the external skin
structure and to reduce the fine lines and wrinkles.

At this point, I think that you should meet with qualified experienced
surgeons and learn about the options. The thing we can’t do with a photo is a
physical exam. It’s very important to understand the function and the support
structure of the eye before undergoing lower eyelid surgery. As a specialist, I
deal with complications of lower eyelid surgery every week and people come to
us from all over the world for resolution. Performing a physical exam including
a snap test to see how well the lower eyelid is supported is critically
important. I always say that lower eyelid surgery is deceptively oversimplified
by many doctors, and unfortunately it results in the eyelid being pulled down
or everted. I hope that was helpful, I wish you the best of luck, and thank you
for your question.

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