Under-eye bags are one of the most common—and most misunderstood—concerns we see in aesthetic practice. They can make you look tired, aged, or stressed, even when you feel well-rested and healthy. Addressing them effectively requires an experienced eye and a profound understanding of facial anatomy.
As a board-certified plastic surgeon with decades of experience, academic training at UCSF, and a career dedicated to both reconstructive and aesthetic facial surgery, Dr. James Anthony approaches the under-eye area with precision and restraint. The goal is never to “erase” your features but to restore balance, smooth transitions, and a refreshed version of yourself that still looks unmistakably like you. In this blog, we’ll discuss what causes under-eye bags, what treatment options you have, and how we can help you make the best choice for you.
What Causes Under-Eye Bags?
Anatomically, the lower eyelid is one of the most delicate areas of the face. Even subtle changes in eyelid fat, skin, or muscle support can dramatically affect appearance.
Under-eye bags can develop for several reasons, often in combination:
- Herniation of lower eyelid fat occurs as the supporting structures weaken with age
- Skin laxity and thinning of the lower eyelid
- Volume loss in the midface, which exaggerates the appearance of puffiness
- Fluid retention or inflammation, sometimes worsened by allergies or lifestyle factors
- Genetic anatomy, which can cause bags even in younger patients
Non-Surgical Options for Under-Eye Bags
Loss of cheek and midface volume often makes under-eye bags appear more pronounced by deepening the hollow beneath the lower eyelid. In these cases, strategic filler placement—typically in the midface rather than directly beneath the eye—can smooth transitions and reduce shadowing.
James Anthony Plastic Surgery offers the following:
- Voluma® is frequently used to restore midface support
- Vollure®, Restylane®, or Radiesse® can soften deeper folds and contours
- Sculptra® stimulates collagen production for patients with diffuse volume loss
Keep in mind that non-surgical treatments are most effective for camouflaging and refining contours, rather than correcting excess skin or significant fat herniation.
Surgical Options for Under-Eye Bags
When under-eye bags are caused by true fat protrusion, excess skin, or structural eyelid aging, surgical intervention offers the most predictable and long-lasting improvement.
Eyelid Surgery (Lower Blepharoplasty)
Lower eyelid blepharoplasty remains the gold standard for treating under-eye bags. Modern techniques focus on:
- Preserving or repositioning fat rather than aggressively removing it
- Selective skin tightening to avoid a hollow or overcorrected look
- Maintaining eyelid support and natural shape
Fat-preserving approaches have been shown to produce smoother contours and more youthful, natural outcomes compared to older excisional methods
(Plastic and Reconstructive Surgery – Evolution of Lower Blepharoplasty).
Cheek Lift
In some patients, under-eye bags may be exacerbated by the descent of the midface rather than just changes in the eyelids. A cheek lift can elevate sagging midface tissues, restore support beneath the lower eyelid, and improve the transition between the eye and cheek. This often enhances the results of lower blepharoplasty when the procedures are performed together.
Facial Fat Grafting
For patients whose concerns stem from volume deficiency rather than excess tissue, facial fat grafting can restore youthful fullness beneath the eyes and through the midface using the patient’s own fat. This option is especially valuable when hollowing—not skin laxity—is the dominant issue.
Brow Lift (Select Cases)
Although not a primary treatment for under-eye bags, brow descent can contribute to a heavy or fatigued appearance around the eyes. In select patients, a brow lift may be incorporated into a comprehensive facial rejuvenation plan to restore upper-face balance.
Addressing Under-Eye Bags Starts with the Right Diagnosis
Addressing under-eye bags—whether through surgical or non-surgical means—is more effective when you understand the underlying causes of the changes and select the right solution for your unique anatomy.
At Dr. James Anthony Plastic Surgery, every recommendation is grounded in a deep understanding of facial anatomy and decades of hands-on surgical experience. As a board-certified plastic surgeon with advanced academic training at UCSF and extensive experience in both reconstructive and aesthetic facial surgery, Dr. Anthony approaches the under-eye area with precision, restraint, and respect for the natural architecture of the face.
If you are considering options for under-eye bags and want clear, expert guidance rooted in anatomy, experience, and evidence-based care, we invite you to schedule a personalized consultation today.
