Firstly, it is most important to establish that we are dealing with a true eyebag and not what is commonly referred to as a pseudo eyebags. In this case the bulge is due to a hypertrophied lower eyelid muscle which can be improved by the simple administration of a toxin to relax the muscle.
So assuming that we are dealing with a real eyebag , there are a few considerations worth mentioning.
1. The severity of the eyebags which takes into account the fat bulge , the laxity of the eyebag skin and the associated tear trough depression. In addition any hollowing of the midface cheeks will aggravate the appearance of the eyebag.
2. Is the patient looking for a surgical correction or a non surgical option . This is where the preference of the patient comes into play although we all know that surgical lower blepharoplasty gives a better and more permanent result.
I will therefore limit my short discussion to what I would normally offer my patients if they are seeking a non surgical alternative.
1, For mild to early moderate eyebags if the patient does not want a procedure with any downtime I would recommend a filler correction to “ hide “ the eyebag . The correction can usually be improved by doing some skin tightening treatment of the lower eyelid region either with a momopolar RF device like Exlilis ot a HIFU device like Ultraformer III which has a dedicated 2mm hand piece especially suited for this area. This treatment is usually done before the filler . In some cases the addition of a filler to the mid Cheek is required to improve the outcome,
2 For moderately severe eyebags where filler injection plus skin tightening is inadequate to hide the eyebags , I would recommend the NILER procedure ( Non incisional Laser eyebag Rejuvenation ) . This procedure was named by me in 2009 when I first started using the Accusculpt laser with a 600 micron 1444nm wavelength fibre optic handpiece. This wavelength of light is primed to induce a lipolysis effect thus eliminating the fat bulge . It also has a skin tightening effect on the area treated . However there is usually swelling after the procedure which can last from 3-7 days. In cases whereby there is a significant undereye hollowing as well a filler would be required at 8 weeks post laser to improve the appearance. Because there is removal of the fat bulge the results do last longer than with fillers alone.
Whatever treatment option you decide upon it is important to discuss with your doctor the aesthetic outcome you are hoping to achieve before making a decision .
Hope this helps.
