Your Questions

Q: Dr. Eppley, I am quite old (66 years old) andI want to know if there is help for severe under eye bags and puffiness?

A: At 66 years old you are far from being too old to have surgery to improve your lower eyes. Such surgeries are safely done on patients up into their 90s. The cause of under eye bags and puffiness is largely herniated orbital fat. As we age the ligaments that hold the fat around the under eye weaken. The fat then gradually spills over the lower bony rim creating the bags that you see. Since such fat is very susceptible to water retention it can get very puffy particularly in the morning or after very salty foods.

Such lower eyelid bags are not treatable by any creams or other topical treatment methods. They can be dramatically improved by surgical reduction/repositioning of the herniated orbital fat to smooth out the lower eyelid. Usually a small amount of lower eyelid skin is removed as well. This is known as a transcutaneous lower blepharoplasty. While there will be some temporary bruising and swelling after surgery, the improvement can be dramatic once it is fully healed weeks later.

If you have any pictures off of your phone that you cane send me I can give a definite opinion as to the benefits of this type of eyelid surgery for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I’m 22 and I’ve had bags under my eyes for a long time. I believe in my case it’s hereditary. I’m tired of hiding my eyes behind my glasses. I would like to know about procedures( a little scared) and around how much it would cost.

A: Given that you are only 22 years old, any bags under your eyes is congenital herniated infraorbital fat. You are too young to have any excessive skin of the lower eyelids. This could be improved by a transconjunctival (through the lower eyelid) blepharoplasty procedure. By going inside the lower eyelid, bulging fat can be removed from the lower eyelid area without an external incision underneath the lashline. This is a procedure that has a very rapid recovery with minimal bruising and swelling afterwards. There is usually a little drainage from the eye area for a few days from the incision inside the lower eyelid. (the incisions are not closed as sutures would rub against the eye ball and risk a corneal abrasion) Patients report little to no pain after the procedure. The typical cost of the procedure would be around $3500 which would include all associated costs.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Dr. Eppley, I am a 42 year-old female and have always had a touch of bags on my lower eyelids.  Due to aging no doubt and some weight loss, these bags seem to have become bigger and at least they seem that way to me. I saw one doctor recently and she told me that I should have injectable fillers put in to puff out the indented areas around them. Then I saw another doctor and he  told that the fat should be removed through an eyelid procedure. These two different opinions have me confused. What do you think?

A: Most undereye bags consist primarily of fat that has escaped from under the eyeball. Our eyeballs are encased in a bed of fat inside the eye socket bones. This allows the eye to be padded so it can move around inside its encasement without risk of being ruptured. This fat is held back by a ligament that runs from the lower eyelid down to the bone. With age that supporting ligament is naturally weak or weakens allowing the fat to come out from under the eye. Much like an abdominal hernia and protruding bowel, the lower eyelid develops bags of herniated fat. Some people have a natural weakness of this ligament and develop lower eyebags very early in life. (I suspect this is you) With aging they become much worse. Removal of this fat can be done from inside the eyelid without any external incisions. (transconjunctival lower blepharoplasty) This would make for a far superior result in your case. Adding more volume around the herniated fat is only going to make your lower eyelids even more puffy.

Dr. Barry Eppley

Indianapolis, Indiana