What can be done about these eye bags? (Photos)

I'm 39. Maybe a little overweight. Kind of an recreational athlete, weightlifter, boxer. My family has these eye bags too. I'm a recreational boxer, will getting punched in the face ruin the results of a surgery (after healing is complete)? Thanks for your response!

Doctor Answers 13

Eye bags

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There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  Boxing complicates the issue as far as healing. It would depend what was done to correct your issue. See below for some common issues and treatments.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Ezcema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,


Chicago Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

What can be done about these eye bags?

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Usually, the best option with natural, long-lasting results is transconjunctival lower blepharoplasty with fat repositioning (see video and link below). Another option is filler injection. See an oculoplastic surgeon for evaluation.

A physical examination is essential here.

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Different issues can cause similar looking eye bags.  This is likely herniated orbital fat but it could also be exposed orbital rim.  An assessment of the shape of the orbital rim determines if you are a good candidate for under eye fillers, an alternative to lower eyelid surgery.  If this is herniated orbital fat, transconjunctival (behind the eyelid) lower eyelid surgery with preservation of the fat so it is transferred to the top of the cheek (arcus marginalia release ) is best.  Seek more than  one opinion and see surgeons who concentrate on eyelid surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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What can be done about these eye bags?

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A temporary fix is a filler injection. A better solution for long term results is a lower eyelid fat pad repositioning (blepharoplasty). See link below for example. 

Surgery is your answer

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These fat bags need to be contoured with surgery.  Risks from injury are there now and will be there after surgery.  This risk is neither increased nor decreased from surgery. 

Lower lid fat pads

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You can do a couple of things here:  HA filler to the tear trough will make the fat pads less noticeable. If you get punched in the lower lids/eye area, the resultant swelling and bruising may make the filler resorb quickly.  The other option is a surgery to move the fat into the tear trough from an incision inside the eyelid.  After the surgery you should avoid boxing for at least a few weeks to allow for healing.  If you get hit there and break the orbital bone you will have a new set of issues no matter what you do for the fat!      

Consider your cheeks as partly responsible

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Cheek position, projection and volume influence what lower eyelid fat is visible. In your pictures, your cheeks are low, causing a longer lower eyelid. Look at pictures of when you were young to compare. In addition, there is volume loss and recession of the upper cheeks, Either from your athletic activities or inheritance, which is hollowing that area and allowing the lower eyelid fat to be visible. Removing the lower eyelid fat is possible, but would add to the hollowing. If you choose a blepharoplasty, have the fat transposed into the cheek edge instead of removed. Consider cheek and tear trough fillers too

Elba Pacheco, MD
Annapolis Oculoplastic Surgeon
4.3 out of 5 stars 7 reviews

Correction of Lower eyelid bags in contact athlete

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You are an excellent candidate for lower eyelid transconjunctival blepharoplasty to treat bags and dark circles with no sutures and no visible scar. 

You would need to avoid cardio and heavy lifting for 2 weeks, and contact sports for another two weeks, then go for it! Full details are on the linked webpage. 

If the above restrictions are too demanding, consider instead the nonsurgical treatment in the video. It has no activity restrictions. 

What Surgery Will Correct The Bags Under My Eyes & When Can I Resume Boxing After Surgery?

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The bags under your eyes are fat pushing a piece of tissue forward called the septum orbitale.  This septum holds the fat back until it doesn't.  Mostly the septum weakens due to genetics.  Once it weakens, the fat not only pushes the weakened septum forward, but also lower eyelid muscle and skin.  

Correction of this protruding fat and tightening of the concomitant skin is done by a lower lid blepharoplasty removing some skin and some muscle, but then creating a dart of muscle at the outside edge of the lower eyelid and then anchoring it upwards to the superior lateral orbital rim (upper outer corner of the bone surrounding the eye).  This type of lower lid surgery which is pulling on the muscle acts in a way to push the fat backward, therefore to some extent, has the muscle itself replace the septum orbitale.  

All the mumbo jumbo above means there is a technique to correct your eye bags, but if I were you, I would not do any boxing for a minimum of 90 days and even better, 180 days.  By 6 months, your muscle sling has turned to scar tissue which is very strong and should not lead to more fat protruding.  On the other hand, don't forget what the referee says and protect yourself at all times.

Lower lid TC bleph

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From these photos, it looks like you would get a homerun result with an upper and lower lid TC blepharoplasty. This procedure would make you look more rested and open up your eye. In my experience the most important thing in assuring a quick recovery from blepharoplasty is minimizing bruising and swelling. Bruising is much easier to prevent that to get rid of. I have all my patients ice as much as possible from the time they get home until they go to sleep that first night. And I instruct them to not recline any more than 45 degrees until they go to sleep that night. And stay away from salt. Patients who follow these instructions generally heal very quickly with little or minimal bruising or swelling. See a board certified surgeon in your area with an expertise in aesthetic surgery for more information. Good luck with your procedure!

Dean Vistnes, M.D.
Vistnes Plastic Surgery
San Francisco Bay Area

#realself #drdeanvistnes #blepharoplasty

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.