Can I treat eye bags with cosmetic filler instead of surgery?
Under eye fillers have become a popular and convenient way to help improve the appearance
of under eye bags.
Filler placement under the eyes require no surgery, and can be performed in minutes to
help camouflage under eye bags..
This procedure can be performed with minimal to no bruising.
It’s important to understand that under eye filler cannot be used in all cases of
under eye bags, and that surgery is often the better option.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
As a cosmetic eyelid surgery specialist, I perform a wide range eyelid procedures every
day such as eye bag removal, treatment of upper eyelid hooding, Asian double eyelid
surgery, and oculoplastic specialty procedures such as eyelid ptosis correction, orbital
and lacrimal system surgery..
I am also well known for my work with injectable fillers for the face, particularly in the
the eye area, cheeks, chin, jawline, and forehead.
Essentially, unlike physicians who cannot perform surgery, I am not limited or biased
in treating the under eye area with any modality.
Many people with under eye bags are relatively young and often hesitant to consider surgery
preferring to have the under eye area treated with filler.
While eye bags can occur and become more prominent due to age, they are mostly caused by genetics,
and can occur as early as during the teen years, and in some cases even younger.
So, what are eye bags ? Eye bags are caused by fat.
Fat normally surrounds the eyes can push forward, like a hernia.
This is why the fat that causes eye bags is referred to as herniated fat.
Fat herniation under the eyes is called lower eyelid fat prolapse.
During consultation, I look at the prominence of the fat and relationship of the herniated
fat to the surrounding bone structure.
For example, there is an area below the under eye bag referred to as the tear trough.
I look to see if the puffiness can be blended with filler in the tear trough.
Generally, I use soft tissue fillers such as Restylane or Juvederm in this area as long
as the under eye bags aren’t too prominent.
It’s important to understand that fillers improve the appearance of eye bags, not by
reducing projection, but by adding projection to the adjacent area.
In some situations where the bags are too prominent for optimal blending, I perform
this procedure as a short term solution for people who want to look better and will undergo
surgery later on.
If the under eye bag projection is past a certain limit, as in the case of more prominent
or severe eye bags, then adding additional volume may not blend the contour of the eye
bags, and actually add more puffiness to the area, making the eye bags look even more prominent.
When selecting a doctor, keep this in mind that many doctors who are not surgeons will
choose filler to treat all eye bags cases, which means in many situations, the filler
placement can result in bigger eye bags.
When eye bags are past a certain level of projection, fillers are not appropriate and
surgery is the treatment of choice.
This surgery is referred to as lower eyelid blepharoplasty.
There are two techniques, one is called the transcutaneous approach where an incision
is made below the eyelashes, to address the fat bags.
The other approach is referred to as the transconjunctival approach where the fat pockets are addressed
from the inside of the eyelids.
In practice, it is common for many doctors to perform the transcutaneous approach to
also remove eyelid skin in an attempt to reduce wrinkling.
In almost all cases, I strongly advise that lower eyelid skin not be removed as it can
lead to complications such as rounding of the eyes, or eye exposure from skin shortage
known as lower eyelid retraction.
Oftentimes, the inside of eyelid is exposed and irritated is due to skin removal.
This condition is referred to as ectropion.
My preferred method is a more specialized technique called transconjunctival blepharoplasty,
where no external incision is made.
I approach the fat pockets from the inside of the eyelid to sculpt the fat.
Since no external incision is made, the results look natural, as if you never had eye bags.
This method preserves the lower eyelid support structures since no skin is removed, and the
anatomy of the eyelid is not compromised by disruption of the muscular support..
When performing eyelid surgery, I most often sculpt the fat to remove the bulge, but leave
some fat behind to create a smooth contour in the lower eyelids, and prevent the lower
eyelids from looking hollow.
Lower eyelid surgery is an art, so not all surgeries are performed the same way.
Having this procedure done with no external incision allow the results to appear natural,
and preservation of fat to prevent hollowed appearance provides for optimal outcomes when
performed by experienced surgeons.
Injectable fillers placed under the eyes is routinely performed with topical anesthetic
for patient comfort.
In addition, fillers like Restylane are also contain some anesthetic.
I usually prefer instruments such as blunt-tipped cannulas instead of needles to reduce the
risk of bruising after the procedure and minimize swelling caused by repeated needle entry.
Generally there is minimal downtime and I see the patient again two weeks after the
procedure to see how the filler has settled, and if additional enhancement is needed.
In my practice, eye bag surgery through the transconjunctival method is performed with
local anesthesia, with LITE sedation for comfort.
I prefer local anesthesia with sedation for almost all my surgeries as my patients are
more comfortable and able to avoid the recovery from the side effects of general anesthesia.
Consequently, my approach results in easier recovery and fast healing from the surgery.
Surgery in my practice is performed in our own in-office surgical suite, certified by
the Joint-Commission for standards of safety and sterility.
Patients routinely go home after surgery without any difficulty..
As far as downtime, patients can return to work pretty much immediately after under eye
In fact, many patients do it over their lunch hour, and return to work afterwards.
There is the possibility of of some bruising after the procedure which typically fades
in a few days.
When performed with local anesthesia, lower eyelid surgery patients return to work in
about a week.
Interestingly, we have found that the limited bruising from lower eyelid surgery can be
comparable to the bruising seen with the use of fillers.
Oftentimes, patients have much less bruising after my performing lower eyelid surgery than
patients who’ve had filler procedures done elsewhere.
The techniques I’ve developed over my career combined with the systems for care and recovery
allow my patients to recovery from lower eyelid surgery much faster than traditional surgery.
I discuss with my patients how to look at their options from a perspective of procedure
Softer hyaluronic acid fillers like Restylane can last 6 months to 1 year before they are
eventually and safely broken down by the body.
The benefits of lower eyelid surgery can last many years.
Once fat pockets are removed, those fat pockets don’t come back.
While there is a chance that other fat around the eyes can prolapse forward the eyelid appearance
can be stable for many years.
Neither fillers or lower eyelid surgery address skin quality such as crepiness.
Supplementary procedures for eyelid skin rejuvenation treatments like laser resurfacing, wrinkle
treatment, and platelet-rich plasma may be considered to address crepey skin, pigmentation
When can you look good for an event: If you want to look good for an event, both filler
and surgery can be performed on relatively short notice.
I look at each individual situation and make recommendations based on my experience.
Filler placement is a convenient option for limited eye bags, with minimal to no recovery.
Lower eyelid surgery is a more definitive procedure that can be performed for any degree
of fat prolapse, with results as if you’ve never had eye bags or surgery.
Patients often choose to have filler placement under the assumption that they don’t have
time for surgery recovery.
In our practice, applying modern, faster healing methods, recovery from eye bag surgery can
comparable to the time it takes for filler results to settle.
Lower eyelid blepharoplasty really brightens up the whole face with minimal surgery.
In fact, many patients who I’ve operated on, comment on the ease of their experience
with their procedure and state that if they had been previously aware of how easy it was,
they would have done it sooner.
I hope you found this information helpful…thank you for your question