The Complete Guide to Under-Eye Bag Treatments

June 6, 2024

Youthful Eyes: How Oculoplastic Surgery Can Help with Under-Eye Bags


At California Oculoplastics and Retina, we specialize in oculoplastic surgery and offer comprehensive care for patients seeking to enhance the appearance and function of their eyes. Under-eye bags are a common cosmetic concern that can significantly impact one’s appearance and self-confidence. The presence of under-eye bags can make individuals look older, tired, or stressed, even when they feel well-rested and healthy. Over time, factors such as aging, genetics, and lifestyle choices contribute to the development of under-eye bags. As we age, the tissues around the eyes, including some of the supporting muscles, weaken. The fat that helps support the eyes can then move into the lower eyelids, causing the lids to appear puffy. Fluid retention, especially upon waking or after a salty meal, can also exacerbate the issue.


Comprehensive Solutions for Under-Eye Bags


Our team of oculoplastics specialists are committed to offering personalized treatments to address your unique concerns, whether they stem from fat prolapse, excess skin, or festoons. By providing a comprehensive range of surgical and non-surgical options, we ensure that each patient receives the most suitable and effective care for their specific needs.

To learn more about identifying which type of under-eye bag issue you may have and the treatment options we offer, continue reading our blog. We cover the various causes and provide insights into both surgical and non-surgical approaches to help you achieve a refreshed and youthful appearance.


Fat Prolapse

Fat prolapse occurs when the natural fat that cushions the eye herniates or pushes forward into the lower eyelid. This can create a puffy appearance under the eyes. Factors such as aging, genetics, and weakening of the orbital septum (the membrane that holds the fat in place) contribute to fat prolapse.


Treatment Options:

  • Lower Blepharoplasty: This surgical procedure involves making an incision along the lower eyelid’s lash line or inside the lower eyelid to remove or reposition the excess fat.
  • Fillers:  For those seeking a non-invasive approach, fillers such as Juvaderm and Restylane offer an effective solution to camouflage the appearance of fat prolapse. These treatments provide immediate results without the need for surgery. While they are not permanent, the temporary nature of fillers allows for adjustments over time to maintain a natural and youthful look.
Excess Skin


Aging and environmental factors can cause the skin under the eyes to lose its elasticity, leading to sagging and wrinkles. This can create a tired and aged appearance. Contributing factors include the natural aging process, sun exposure, and lifestyle habits.


Treatment Options:

  • Lower Blepharoplasty: This surgical procedure involves making an incision along the lower eyelid’s lash line to remove or tighten the excess skin. The result is a firmer, more youthful appearance.
  • Chemical Peels: These treatments involve applying a chemical solution to the skin, which removes the damaged outer layers and promotes the growth of new, smoother skin. This can improve skin texture and reduce wrinkles.

Festoons, also known as malar bags or malar mounds, are swollen, puffy areas that appear below the lower eyelids and above the cheekbones. These are typically a result of fluid retention, lax skin, and weakened muscles in the midface area. Unlike fat prolapse, which occurs directly under the eyelid due to herniation of orbital fat, festoons are more pronounced on the cheeks and give a distinct “puffy” look to the upper cheeks, contributing to an older and more tired appearance.


Treatment Options:

  • Lower Lid Blepharoplasty: While traditionally used to address under-eye bags, lower blepharoplasty can also be adapted to treat festoons. The procedure involves making incisions along the lower eyelid to reposition or remove fat and tighten the skin.
  • Mid-Face Lift: A mid-face lift targets the cheek and midface area, lifting and tightening sagging tissues to reduce the appearance of festoons. This procedure not only addresses festoons but also enhances the overall contour of the midface, resulting in a more youthful appearance without noticeable scarring​
  • Tetracycline and Doxycycline Injections: Recently, these antibiotic injections have been found effective in reducing festoons. They work by tightening the loose tissue and reducing fluid accumulation in the affected area.
  • Direct Excision: Direct excision involves surgically removing the festoon tissue. This method effectively reduces the puffiness by precisely excising the excess tissue, leading to a smoother and more youthful appearance in the midface area.

Schedule a Consultation with Our Specialists


If you’re dealing with under-eye bags and are seeking effective treatment options, schedule a consultation with our experts today. At California Oculoplastics and Retina, we specialize in providing personalized treatments tailored to your unique concerns, whether they stem from fat prolapse, excess skin, or festoons. Our comprehensive range of surgical and non-surgical options ensures that you receive the most suitable and effective care for your needs. We prioritize patient comfort and satisfaction, and our team is dedicated to determining the best approach for each individual during your consultation. Take the first step towards a rejuvenated look by contacting us now!


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