Am I Too Young for Lower Eyelid Surgery? How Do I Correct DARK, Puffy Bags at 23? (photo)

Hello, I'm 23 and work in entertainment television. I'm conscious about these eye bags which I've had all my life and are probably genetic in origin. They are very hard to conceal even for some of the professional makeup artists because of the dark colour. They are also puffy. I've seen two surgeons about this. One said he'd do lower bleph by making an incision inside the eyelid. The second said he'd just use a filler because I'm young. Fillers wont correct the colour though. What do I do?

Doctor Answers 9

You aren't too young for lower eye bag surgery, and evidence of surgery won't be seen even in HD. Darkness can be treated

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Lower eyelid fat prolapse is a condition where the fat around your eyelid has pushed forward. This is typically a genetic problem especially if it happens when you are younger.

A temporary solution is a filler like Restylane to fill the area and may camouflage the puffiness. But the unfortunate reality is that a good number of patients who have fillers placed made their puffy bags even bigger.

An appropriate procedure would be transconjunctival blepharoplasty. This is a procedure where the fat pockets are addressed from the inside of the eyelid. This way there are no outside scars and you don’t look as if you had surgery.

When you have ethnic  darkness, or pigmentation that is genetic, there’s really very little to change that. People have tired all kinds of bleaching creams but those don’t work very well. Some patients of mine have pigmentation because they aggressively clean the area where they place make-up. Invariably, this causes the skin to become rough and become dark.

For patients who have ethnic pigmentation, usually I will not do a laser that generates heats like a fractional CO2 laser. I prefer something called platelet-rich plasma and inject it under the skin to help improve the health of the skin. This is a material that is derived from the patient's blood and the platelets are isolated by spinning it. Platelet-rich plasma stimulates healing response in the body and stimulates collagen to improve the skin quality and texture under the eyes.  I hope that was helpful, and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 79 reviews

Dark Circles, Bags, and Tear Troughs Under the Eyes Respond Well Nonsurgically To Fillers

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Many of the changes we typically encounter in the lower lids with the passage of time--namely tear trough deformities, hollows and bags, result from shrinkage, shriveling, and a downward descent of the once robust, heart-shaped fat pad that sat immediately under the lower lids and extended out toward the temples, inward toward the root of the nose, and downward about half-way to the angles of the mouth. The loss of this volume and its downward displacement in the direction of the jaw (due to weakening of the supporting ligaments and the downward pull of gravity) elongates the lower lid to several times its narrow youthful width and leaves it somewhat sunken. In addition, like a balloon having lost its air after being fully inflated for a long while, the skin of the lower eyelid fails to snap back to its youthful smoothness, and instead remains crinkled and baggy. Occasionally, we see these same changes based on a family trait predisposition..

Today, we can attempt to address these problems nonsurgically with the injection of fillers and volumizing agents to restore the volume to the lower lids and recontour them, mask the bags, and diminish the darkish discoloration.

A variety of have been tried for these purposes. My personal favorites for dealing with tear troughs--for providing overally smoothness, shape and lift-- are the recently approved Belotero Balance and Restylane L. When more cheek support and buttressing are needed for the lower eyelid, the upper inner cheek immediately below may be supplemented with with Perlane L, known for its lifting capacity. To counter the darkness, a small amount of Radiesse may be added to the syringe. Its white color works well for this purpose..

In my experience, while more prominent bagging may be improved considerably with this approach, some degree pf bagging typically persists following treatment. On the other hand, for mild to moderate bags, it usually takes about five minutes to treat each lower lid with immediate that typically evoke a "Wow!" response from patients when they look in the mirror.

While minimal bruising, tenderness, swelling and redness may occur following treatment in this delicate region, these are usually temporary and disappear spontaneously within one to seven days. Most people can return to work or social activities immediately or the following day and coverup may be used if desired.


Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Trans-conjunctival lower blepharoplasty for fat bags

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  The pictures  are taken from a very unnatural position and it's impossible to give a determination as to what needs to be done with those photographs. The primary goal for lower blepharoplasty in the young age group is to remove a portion of the 3 little fat pads causing the herniation and puffiness.  A trans-conjunctival approach is used for for removal of a portion of the herniated fat 3 compartments in the lower lids.  This incision is placed on the inside of the eyelid so there is no external incisions. It's also important make sure there is no pre-existing allergies her thyroid conditions.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Dark puffy bags

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The photo is helpful, but an in-person evaluation is more valuable. In general, there are three reasons why the skin around the eyes can be [or seem] darker:

1. The thin eyelid skin allows the darker muscle underneath to show

2. The contrast between eyelid fat bulging, and hollowness at the orbital rim [tear trough] eyes can create a shadow effect that exacerbates darkness.

3. Skin pigmentation [sometimes from blood products from bruising]  If it is blood    product pigmentation, it could last months to improve.

Depending on which of the above is the issue, different modalities may be helpful [time, fillers, laser resurfacing, concealer etc].

In your case, it seems that its a combination of prolapsed fat [hereditary] and darker skin. A transconjunctival blepharoplasty with fat transposition [instead of removal] would be  a great permanent solution for you. However, fillers may be effective as well, and are less expensive up front, but will need to be repeated every 9-12 months [sometimes longer]

Make sure you consult with a surgeon that is experienced in both the surgical and injectible fillers.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Lower Eyelid Surgery for Dark Puffy Bags ?

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Puffy bags and dark circles on the lower eyelids can be related or separate issues, and therefore they may be treated together or separately.  The puffiness is usually due to fat deposits in the lower lids that bulge forward with aging, and can be a family trait.  These puffs can be corrected by either removing the fat or repositioning it.  The repositioning of the fat can both reduce the bags and fill in/smooth out the grooves below the bags.  These grooves are usually the area of "dark circles".  Sometimes these grooves are darker because of a shadow effect, in that the light hits the higher contours above and below the grooves, but the grooves remain in a slight shadow.  In that case, reducing the bags or repositioning the fat into the grooves can help "lighten" this area.  Using fillers to plump up these grooves can also reduce the shadow effect.  However, if the darker color is due to actual darker pigment in the skin, then the treatment is less successful.  In such a case, a chemical peel or laser resurfacing may help lighten the pigment, but doesn't always work.  Recently, some doctors have reported placing fat grafts under this skin to fill in the grooves, and they feel that stem cells in the fat help improve the skin quality resulting in lighter pigmentation.

Richard G. Schwartz, MD
West Palm Beach Plastic Surgeon
5.0 out of 5 stars 32 reviews

Am I Too Young for Lower Eyelid Surgery? How Do I Correct DARK, Puffy Bags at 23?

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      The pictures are a bit difficult to evaluate, but lower eyelid surgery for fat removal or Restylane to the tear trough would be two alternatives.  I would start with the Restylane.  The pigmentation may be partly shadowing.  Kenneth Hughes, MD Los Angeles, CA

Dark puffy eyes.

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The puffiness is removed thru the inside of your eyelids to remove the fat conservatively.  The pigment can be improved with bleaching agents or peels. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

Puffy bags under eyes at 23

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It's difficult to tell from your picture exactly what the problem may be.  If you do have bags under your eyes caused from protruding fat, then surgery can be done to address that issue.  In most cases, when bags under the eyes are removed, it will improve the darkness underneath if it is caused from shadowing from the bag.  Fillers can be another option for treatment, but the results would not be long-lasting.  If there is a depression under the eye, the filler can be used there to fill the depression, which can sometimes improve the darkness by reducing the shadowing.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

The photo you posted make is almost impossible to know what you need.

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It looks more like you have a circle rather than a bag.  If that is really the case, then what you will benefit from is lower eyelid fillers rather than lower eyelid surgery.  A personal consultation is what would be helpful for you.  Whatever you do, less is more.  If you have a bad lower eyelid surgery result most producers won't touch you so please be careful out there.

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