What Causes Water Retention Under my Eyes?

I am 47 years old and I have developed malar edema. It sits right above my cheekbones and will not go away. Should I find out if there is an underlying health condition before I go to a plastic surgeon and if so, what type of tests should be done? Thanks

Doctor Answers 6

"Water Retention" Myth

What people usually (mistakenly) refer to as "water retention under the eyes" is actually fat prolapse. The fat can become more prominent for different reasons. The bags look larger in the morning because they become more swollen as we sleep on our backs. Allergies may also increase the swelling as can some medical conditions. It is best to seek an in-person consultation with your Oculoplatic Surgeon to determine an appropriate treatment plan. I hope you find this helpful.

Fluid retention under eyes

Hi Lisa

I know how frustrating your condition can be.  As stated by the other doctors checking for a familial predisposition should shed some light as to the cause.  However, I have found this problem to be what we as doctors call, multifactorial (many things can lead to it).  You should check with your primary doctor if any medical condition can be adding to the problem (something that would cause you to retain salt). 

As far as treatment options.  Surgery can aggravate the condition and cause more or new fluid retention.  Mechanical compression with tape at night, etc. is very unpredictable if at all helpful.  Some of the more aggressive lasers which remodel the skin and deeper tissue have shown some success - but with prolonged recovery.  I and some colleagues have attempted inserting a metal probe (insulated) to the area and applying heat to shrink and tighten the tissue and reduce fluid.  This is generally benign and has had variable success.

I think a consultation with a specialist is worthwhile so the tissue can be seen and felt.

Best of luck

Guy Massry, MD
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 38 reviews

Water Retention and Eye Bags

Hi Lisa Bone,

Eye bags have multiple causes, with each having various contributions to facial appearance. Bags are commonly due to eye fat which protrudes a little from the eye socket, in addition to sagging eyelid skin & muscle or edema. One also looses facial fat in the skin & cheeks from age. Weight fluctuations will affect eye bag appearance. Allergies and hormonal conditions will affect eye & cheek bags too. Lastly, water retention will affect the face from such factors as diet, medication, heart, or kidney conditions.

You may start with a visit with your primary care physician, or seek the opinion from a plastic surgeon. After a comprehensive evaluation can a specialist help determine the cause of your specific eye bags and provide some treatment options. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
5.0 out of 5 stars 68 reviews

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Eye Bags Often From Fat Herniation

Thank you for your question. Most times, excessive swelling under the eyes is not caused by fluid retention, but by excess fat which has herniated. these eye bags are collections of fat that usually require surgical removal. Most of the time, in young patients, these bags can be removed through the inside of the eyelid with no scar. I would suggest a consultation with a board-certified plastic surgeon with experience in eyelid rejuvenation. Best of luck, Dr. Pacella

Fluid retention lower eyelids and cheeks "malar bags"

Malar bags are small sacks of edema that accumulate over the cheek bones in people who are genetically predisposed to have it occur.  You can try and cut down on your salt intake and see if they improve.  There are no surgical ways to reliably decrease malar bags...but I have been successful in people who are also candidates for Cheek Augmentation, by improvong the Cheek Shape with Cheek Implants that camouflage the malar bags.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.5 out of 5 stars 17 reviews

Consider seeing an oculoplastic surgeon.

Dear Lisa

There is what doctors call a differential diagnosis for malar swelling.  However, for many this change is associated with aging and family genetics.  So if all the women of your family have a similar issue as they age, that is most likely the answer.  Yet there are other possible causes so if the malar festoon is newly acquired and not a feature of your family, a consultation to address possible medical causes is reasonable.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

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.