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what's the best treatment for under eye bags? i'm 29 and mother of 2. my under eye bagsafter my 2nd child have become more pronounced. what are my treatment options? i'm lookingfor longer term solutions and not completely opposed to injectables, although i worry abouttheir safety in the long term. thank you for your question! you’re 29 years old and you stated thatafter your second child, the under eye bags became more pronounced and you want to knowwhat’s the best solution. and that you are willing to entertain option of fillers althoughyou are concerned about the long-term impact of these fillers. well, i certainly thinkthat anyone who’s been a parent will nod

their heads and say how their under eye bagsbecame more pronounced as they had more children. i could say that with the photos you submitted,there are certain observations that i’ve made that i’d like to share with you. to give you a little bit of background, i’ma cosmetic oculofacial plastic surgeon practicing in manhattan and long island for over 20 years.oculofacial plastic surgery is a specialty where doctors are first trained in eye surgerybefore doing super specialized training in cosmetic reconstructive surgery of the eyelids,the orbit or the bones, the lacrimal system, the tear gland and tear duct system. in addition,i’m also board certified in general cosmetic surgery, facial cosmetic surgery, breast andbody etc. so i’ve been treating under eye

bags for over 20 years and suddenly, there’sbeen an evolution in the many options that we had to optimize the appearance of the undereye area. now, when i look at your photos, i noticeclearly the puffy under eye bag. so let’s define what that is. that puffy area is calledlower eyelid fat prolapse. it means the fat that’s normally around your eye has pushedforward and created this bulge or hernia and that’s the dominant feature. although idon’t have a picture of your whole face, i’m sure that when you are looking the mirror,that’s what you’re seeing first. when i look at patients and particularly becausei also do a lot of facelift and a lot of facial rejuvenation, cheek implants and volume correctionand other things to rejuvenate the face, i

always look at the eyes also in the contextof the whole face. and what i would suggest you would observe when you take a step backis look at the eyelid to cheek area or the volume in the cheek. what we have observedover anecdotally is that women after having children tend to lose a lot of fat in theirface. not everybody but a significant number of women report that they lose volume in theface. so how does this impact the treatment planfor the under eye bags? well, for one thing is to be aware that there may be an optionto consider after the lower eyelid is addressed which involves adding volume to the cheekarea. so what i try to do in my patients is to demonstrate for them the paradox of toomuch puffiness under the eye meanwhile volume

loss in the eyelid cheek area. so understanding that for the under eye bags,i think that most likely it would more of a surgical candidate rather than a fillercandidate because one of the limitations of fillers is simply that the more the eyelidpuffy bags bulges relative to the bone, the less you can really camouflage without makingit look puffy. and we deal with that situation when patients come to us having had this doneelsewhere, we have to use an enzyme called hyaluronidase to dissolve the material. so in your situation, i would recommend alower eyelid transconjunctival blepharoplasty. this means addressing the fat pockets fromthe inside of the eyelids. this procedure

we perform in our practice under local anesthesiawith lite™ intravenous sedation. that means you don’t have to go under general anesthesia.and as additional supportive procedures to help skin quality, we do fractional co2 laserwhich is a laser to help skin texture and quality. and we also use something calledplatelet-rich plasma. platelet-rich plasma is derived from your own blood and we haveused it to help under eye dark circles. so in a combination approach, we are able toreally rejuvenate the under eye area. just to finish the thought on platelet-richplasma, we derive it from your own blood and we spin it and use the growth factors responsiblefor wound healing that are very effective in improving the color, quality and the healthinessof the lower eyelid skin.

when it comes to the cheek volume, we usefillers of different types such as restylane, juvederm and we also combine them with platelet-richplasma so that there is harmony. there is a balance and you can certainly look a lotmore refreshed even though you’re fatigued from parenting. so i would say that you have a pretty solidoutlook in terms of being optimistic because the thing that i look particularly about lowereyelid surgery is how impactful it is on the person’s facial expression. nothing saysthat you’re older, tired and lacking in energy than lower eyelid bags. and our patientshave said for years that they’re tired of looking tired.

so i think that finding an experienced andqualified cosmetic surgeon specializes in this area will help you make this decisionand accomplish what you want to accomplish. so that you can at least enjoy your appearanceas time goes on. certainly, you won’t be able to address it any other way effectively.certainly you can try fillers but i don’t think that would be advisable. so i hope that was helpful, i wish you thebest of luck and thank you for your question!