I Have the Worst Bags Under my Eyes, PLEASE HELP :(

For someone your age with relatively smooth and elastic lower eyelid skin, I too approach this problem with injectables, preferably Radiesse layered along the infraorbital rim periosteum with extreme care and circumspection under regional anesthesia in the office, patient sitting up and following the result with me in the mirror as we progressively transform a hollow lower lid that absorbs light to a more full, naturally beautiful lower lid that youthfully reflects light.

Silicone is permanent, and I have no experience with it, except seeing some patients with associated problems.

Neither blepharoplasty nor canthopexy is the ideal solution to this problem. As most surgeons have indicated, injectible fillers will give you the best result with the least amount of risk.

The discoloration will be very difficult to address as the eyelid skin is quite thin and often will not hide the color of the underlying muscle.

Good luck

seattleface com

I read your concerns and reviewed your photos:

You have lower eyelid grooves (tear-troughs) that extend down into your midface. In my view, this is not a surgical problem. You may have your lower eyelid grooves filled, and this would decrease the appearance of "bags". In my practice, Silikon-1000, an off-label filler for permanent results, works well for eyelid grooves.

Please be sure your physician is experienced in the delicate art of injecting eyelid skin, as this is an unforgiving area.

I hope this is helpful for you.

Regards from NJ.

Lewis 

Under eye fillers will do a great job addressing the under eye circles.  Please recognize that this type of treatment is an art form.  Do not let a nurse or family doctor do this treatment.  You need someone who actually does a great deal of under eye filler service to address this issue.  Consider looking on the liquidfacelift website to find someone in your area who can help you.

Hi

So bags mean many different things to different people.  From your photo which does not replace a good examination you have a depression under the lower lids in the inner/middle part of the lid - we call this a nasojugal groove or sometimes a tear trough.  This can be addressed with a filler such as Restylane.  The discoloration may improve with this treatment also.  You also need to be evaluated for conditions which may predispose to this.  A well trained eyelid expert in your area is the best person.  You can go to the we site asoprs.org to search doctors in your location.

Best

 

Dr. Massry

In reviewing your pictures, I don't appreciate lower lid orbital fat herniation (pseudo-) but rather deep tear troughs extending into the midface. This is a transition issue and is cause by lack of soft tissue volume between the lower lid fat and cheek tissue. Temporary improvement can be achieved with HA soft tissue injection (reversible with hyaloronidase if necessary). This is highly operator dependent and requires skill and experience. The other longterm solution is a tear trough cheek implants with or without malar/submalar components. Implantech makes a great tear trough implant and it can significantly improve facial contour and hollow eye appearance. The tear trough implant may require a subconjunctival (inner eyelid) incision which has no visible scar and the malar/submalar implants will require incision above the gum line through the mouth and again no visible scars. The placement of implants does require sedation but can be performed in the office with a relatively short recovery time.

I see many young patients who have similar complaints of dark circles under the eyes that is accentuated by the groove that forms from the inner corner of the eye.  This crease  is termed the nasojugal groove or tear trough.   The problem is that this depression creates a shadow and makes the dark color appear worse.  I generally recommend a soft tissue filler such as Juvederm or Restylane to fill this zone.  These two hyaluronic acid gel products are ideal for filling this zone.   The injections must be done deeply along the orbital rim and then gently distributed along the crease.  The tear trough is due to several factors including loss of fat volume, confluence of several facial muscles and the collision between the weak tissues of the eyelid and thicker tissues of the cheek. Darkness under the eyes is not due to pigmentation of the skin.   So bleaching type agents will not be effective.  I would recommend the use of a  topical product, Teamine.   This product helps to reflect light thus reducing the dark appearance.   A combination of these two treatments can result in a more youthful appearance this area.  .  

You have a tear trough volume loss as you have begun to lose some of the "baby fat" from your face.  This can be easily corrected with Restylane hyaluronic acid filler.  I have personally performed thousands of these injections and by far this is the best option for you.  Results last around 1 year as we studied this with 3D camera imaging and it is published in the plastic and reconstructive surgery journal.  See this publication for details:  Donath AS, Glasgold RA, Meier JD, Glasgold MJ.  Quantitative evaluation of volume augmentation in the tear trough with a hyaluronic acid based filler: a three-dimensional analysis.  Plast Reconstr Surg. 2010;125(5):1515-22.

Your posted photos show thinning of the inner quarter of the lower eyelid skin and fat. The color you see is the underlying muscle visible after the overlying tissue thins. In addition to the muscle you also see the edge of the bone rim under the eye due to this thinning. When you can see the rim from the outside it is called a tear trough. I do not see any lower eyelid bags in the photos.

You can find more detailed information in the referenced webpage.

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.

Lower eyelid concerns may be treated by a variety of procedures depending on the problem.  A complete evaluation is important. The tear trough area may be treated with a filler such as Restylane.  The filler adds volume to the area of depression improving the contour of the lower eyelid.