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Lower Eyelid Rejuvenation: How To Fix Under Eye Bags

August 1, 2019

Are the bags under your eyes Prada? 

Have you spent your entire paycheck on eye creams and concealers?

Since you can’t actually fill in your deep under eye wrinkle with spackling compound, maybe you’ve become an expert at concealing with makeup, but with minimal improvement.  

Lower eyelid bags are often a sign of lack of sleep and aging, and occasionally genetics. The main concerns with the under eyes are puffiness, discoloration, and deep hollows. 

I’m here to tell you the reason you’re having these issues, and the best nonsurgical and surgical treatments to make your under eyes a thing of the past!  

Eyelid Bags

Under eye bags are usually caused by bulging of the fat in the lower eyelid. Everyone has small pockets of fat in the lower eye, but occasionally it bulges through the lower eyelid muscle and skin. As we age and our fat pockets begin to sag, this becomes more noticeable.  

Non surgically, I can camouflage them by placing dermal filler just underneath the bags. You still have the areas of fat that bulge through the skin, but the dermal filler masks them. This procedure lasts about 1-2 years, when the dermal filler will eventually be absorbed by your body.

Surgically, I can remove this fat under the muscle and skin. As you can imagine, the amount of fat removed is quite small, and the procedure requires delicacy.

In some patients who have small bags, I can do fat grafting by harvesting fat from somewhere on your body, filtering this fat, and then placing your fat carefully under the skin to fill in your under eye wrinkle. 


Puffy Lower Eyes

Puffy under eyes may be more noticeable with lack of sleep, stress, and aging, but some of you may simply have been born with this condition. The best theory explaining visible puffiness is that the way your body drains fluid – through the lymphatics – may not be as efficient as possible. This is why some very young patients may have puffy lower eyelids.

Non surgically you probably know of multiple ways to reduce puffy lower eyelids, including cold compresses, rest, head elevation while you sleep, and more. Dermal filler placed underneath the puffiness, assuming you have a lower eyelid wrinkle, is a great way to camouflage this as well.

Surgically, releasing the lower eyelid area and placing fat in the area is the best way to treat the puffiness.


Under Eye Wrinkles

Under eye wrinkles occur when you have a deep wrinkle under your eyelid. Makeup can help, but even the best concealer may not be able to totally hide this deep area in relation to the rest of your eye.

Non surgically, dermal filler is a great way to directly hide the under eye wrinkle. I carefully place dermal filler with a cannula into the lower eyelid wrinkle, all the way from the edge of eye near the nose to the sides of the lower eye near the cheek bone. Dermal filler should last about 1-2 years after injection.  

Surgically, I have to release this deep wrinkle. There is a ligament that creates this wrinkle –  the orbitomalar ligament – and by releasing it, your wrinkle will no longer be held down to your cheek bone. I then have to fill this area with your own fat so that the deep lower eyelid wrinkle will no longer be present. This type of procedure should have long lasting results, typically 10 years or more.  


Dark Circles

Dark Circles under the eye are due to skin discoloration of your skin, and can be made worse by the deep wrinkle under your eyelid. Sometimes skin cream and lightening agents may help, but if they do not work, then you may have either a non surgical or surgical procedure.

Non surgically, dermal filler placed in the area of dark skin, especially if you have a lower eyelid wrinkle, will immediately have a small effect on discoloration. Over the next several months, you will see continued improvement of the dark circles.

The ultimate filler is fat, so with surgery, I can fill the skin under the dark circle and in the deep wrinkle with your own filtered fat, resulting in a significant improvement in your lower eyelid discoloration and very long lasting results. These results should last many years.  

Bags, puffiness, wrinkles, and dark circles are very common problems with the lower eye, and you have several non surgical and surgical options available for you. Please call my office at (415) 362-1846 or email to set up a consultation, and we will come up with a plan that works best for you.


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