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Bags Under Eyes Treatment Options

Under eye puffiness is one of the most common facial issues affecting a wide range of people regardless of gender, age, or ethnicity. This appearance is caused by orbital fat which is normally around the eyes, herniating or pushing forward, resulting in the appearance of bags under the eyes. This type of under eye bags is not affected by sleep or diet. It’s routine for me to hear from patients about how frustrating it is to have eye bags which makes the people they interact with think they’re tired or lacking sleep.

In addition, what’s often mentioned is that people they meet think that they’re older than they really are. Again, eye bags that are always visible are likely caused by orbital fat normally around the eyes pushing or herniating forward, creating bulges under the eyes. Medically speaking, these eye bags are referred to as lower eyelid fat prolapse.

Generally, under eye bags are a genetic trait, so even younger people can have eye bags. With the recent growing popularity of fat reduction options, some people inquire about having the eye bags removed with an injection to melt the fat. I’ll discuss the difference between fat around the eyes in comparison to other areas of the body and how I approach helping my patients in the way I feel is the safest for them.

woman with under eye bags

As an eyelid specialist, I perform a wide range of procedures to enhance the eye area including non-surgical procedures such as lasers and fillers. I routinely perform eye bag surgery as well as upper eyelid surgery for hooded eyes, double eyelid surgery for Asian eyes, ptosis correction surgery, and revision eyelid surgery for complications referred by other doctors.

When I see a patient in consultation for under eye bags, I look at the situation from an anatomic perspective and consider both surgical and non-surgical options. As mentioned earlier, lower eyelid fat prolapse makes under eye bags bulge forward. This creates a “hill next to a valley” relationship where the valley is an area of relative hollow called the tear trough.

Another key anatomic variable is the projection of the bones, which define the cheek including the area directly below the tear trough. I also look at the balance in shape and projection of the cheekbone in relation to the under eye area.

Can Fillers Help with Under Eye Bags?

I frequently help my patients camouflage puffy under eyes by placement of hyaluronic acid filler into the tear trough. I look at the relative shape and projection of the cheek and cheekbone area. When there is a deficiency in these areas, I also place thicker hyaluronic acid filler at the bone level to create a natural harmony between the under eye and cheek areas.
bags under eyes treatment before and after fillers
under eye filler before and after
I perform this enhancement by a method called Structural Volumizing using blunt cannulas and applying the principles derived from performing facial implant surgery to create natural results typically without bruising or extensive swelling

Can Plastic Surgery Remove Bags Under Eyes?

Eye bags can also be more definitively treated with a procedure called lower eyelid blepharoplasty. I often see patients who first used fillers to camouflage the under eye bags and the adjacent hollow tear troughs until there came a point where the fat pockets became too prominent to camouflage, making blepharoplasty the appropriate next step. When it comes to any cosmetic surgery, I always advocate procedures which in my hands are safe, predictable, have low risk for complications, and with minimal recovery time.

bags under eyes treatment surgery recovery after 1 month
bags under eyes treatment options: surgery recovery after 1 month

Are Fat Dissolving Injections Safe for Under Eye Bags?

So, does the injection of a fat reducing chemical into the same space occupied by the eye meet these standards? In my opinion, at this time, the answer is no. A chemical, which exists in the bile for the digestion of fat, has been marketed for fat reduction under the chin. Doctors are taking the same chemical, called deoxycholic acid and using it for fat reduction in other areas of the body.

Here’s the problem – the injection of deoxycholic acid under the skin causes significant inflammation and swelling to varying degrees. It’s common to see the injected area become red, inflamed and swollen for several days after the injection. Although this inconvenience is not usually dangerous to the skin, the same cannot be said if this level of inflammation were to occur in the tissue space around the eye.

Unlike the skin, the fat around the eyes is part of a deeper and complex structure intimately connected with the eye. Inflammation could result in scarring, double vision, and even vision loss.

I’m actually concerned that the growing proliferation of cosmetic services provided by non-surgical physicians as well as non-physicians who were never trained in surgery will experiment with injection of deoxycholic acid on their patients to help them avoid surgery.

confusing credentials non-surgical physicians

Common Reasons Why People Avoid Under Eye Bag Surgery

So why do some people try to avoid surgery and waste their time, money, and even contend with swelling and bruising when they get injections done by other practitioners just to avoid surgery? Worse, why would someone even risk their vision by trying a fat dissolving injection?

The objections that people who want to avoid surgery in my experience come down to:

  • The cost
  • The fear of surgical complications
  • The fear of visible scarring
  • The fear of anesthesia complications
  • Seeing people, particularly in the media whose eyes they feel look unnatural
  • And the limited time they have to be away from responsibilities such as work and family

Well, from the time I was in training, I looked at cosmetic procedures with the same perspective. More than 20 years ago, I advocated for cosmetic procedures which were affordable without compromising safety standards, minimizing risk of complications, and avoiding incisions which eliminates visible scarring.

I also advocated local anesthesia as opposed to the more standard general anesthesia, which significantly reduces risk of anesthesia-related complications. As far as an unnatural appearance is concerned, I personally feel pain whenever I see someone in the media or in person who has a typically operated and stereotypical plastic look. As someone who is artistic and creative, I’m very aware of seeing disharmony, which I think we all are intrinsically sensitive to.

Patients will often mention someone they know or see in the media and say, “they just don’t look right”. This speaks to the synergy between the surgeon and the patient about what kind of results both are expecting. Many times, both the surgeon and the patient share the same vision for a body dysmorphic and exaggerated look, which also applies to procedures such as lip filler, and Botox. When it comes to time away from responsibilities, I developed processes in preparation, surgery and aftercare, which allow my patients to minimize their downtime.

What is the Best Treatment for Under Eye Bags?

In my practice, I routinely address under eye bags that are too prominent to camouflage with fillers by performing a procedure called transconjunctival blepharoplasty. This means I perform the surgery from the inside of the eyelids thereby avoiding any incision on the outside. I often combine this procedure with other procedures to improve the skin quality such as PRP or platelet rich plasma and fractional CO2 laser.
before and after male upper and lower eyelid blepharoplasty with fractional CO2 laser and platelet rich plasma PRP
before and after male upper and lower eyelid blepharoplasty with fractional CO2 laser and platelet rich plasma PRP
I also routinely perform filler placement at the same time such as Structural Volumizing for cheeks, chin, and jaw angle, which complements the eyes with a more balanced and youthful face. I perform these procedures in my private operating facilities within my offices in Manhattan and Long Island under local anesthesia with LITE IV or intravenous sedation.
cosmetic surgery bags under eyes treatment and cheek filler before and after results
best surgical treatment for bags under eyes before and after results

I perform this procedure with a focus on preserving the natural shape of the eyes such that the eyes appear, as they would have if no bags were present. I have found that this maintains the intrinsic character of the patient’s eyes.

I’m often told that when their friends and family see them, they know that the patient looks better, but they can’t put their finger on why – that is a natural aesthetic. My patients walk out after surgery comfortably, smiling and thanking my staff, and look ready for work in about 1 week.
When it comes to any procedure close to the eyes, protecting your vision and health of your eyes is always the highest priority. At this time the risk associated with the inflammation caused by the fat dissolving chemical deoxycholic acid makes the eye bags an area I would not treat with this chemical.

When it comes to addressing under eye bags, I have been able to successfully provide my patients with a surgical solution which in my hands has resulted in a natural and refreshed appearance, with minimal risk, and a quick recovery.

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