What is the Best Treatment for Under Eye Bags? I have had these under eye bags my whole life and I don't like the way they make me look. I am tired of being mistaken for looking sad or sleepy when I'm not. I have tried every remedy in the book and they had no effect on me whatsoever. Makeup does nothing to conceal the shape of the bags as well as the puffs. I really want to know what my options are as far as removing them and which option is best for me based on my picture. Thanks! Thank you for your question! You've asked what's the best treatment for under eye bags well its good your asking this question in a forum were physician can answer because many of our patients as a specialist in ocular facial plastic surgery have come to be with bags and bags and bags of over the counter guarantee to get rid of puffiness creams which do nothing and so you describe the typical concerns and experiences of our patients have where they say they have bags now matter how much they sleep, they always look tired and make up cover doesn't help so when you ask the question what's the best approach lets first learn of the cause of the under eye bags. The under eye bags represent the fat pockets and this terms is called lower eyelid fat prolapse. What that means is the fat that's normally around the eye pushes forward and creates a bulge. Typically this is a genetic trait. It can happen as early as teen years and it can happen throughout the life time of an individual. In fact, they actually transcends age, ethnicity you name it, gender. Bags under the eyes are one of the most common procedures that I treat in my practice. Now many years ago, in plastic surgery, traditionally, approach the bag with one approach which is called transcutaneous approach or an incision on the outside. And most general plastic surgeon were trained in this one technique. In the late 90s, I actually wrote an article called "Ethnic Consideration on Eyelid Surgery". I realized that for different skin types and different ethnicity, we have to customize the approach to the eyelid appearance and compensate in many ways to the different anatomical aspects of each ethnic group. So from my experience, someone like yourself come to my practice, I would perform something called transconjunctival blepharoplasty. What that means is it will get to the fat pockets from the inside. I would remove and reposition as appropriate and then you'll have no incision on the outside. People with dark skin have tendency to have some type of mark if the incision is done on the outside. Not everyone but that's the risk that's not usually necessary in someone who's in the young to middle age group as long as there is no extra skin. And most of the time, when it's perceived as extra skin, is not extra skin the bulge of the fat pocket skin will then it's called Convexity. When the fat is removed, it has to follow the same surface area or relative concavity. In addition, in the past several years, I have a lot of success applying a material called platelet rich plasma. What I'm doing essentially is using your own platelets. So that basically is drawn from your own blood and spinning it until we get this part of it that is concentrated with platelets. What platelets are is the natural way of the body to heal and there are all these growth factors that help improve skin quality. So I would typically combine lower eyelid blepharoplasty or transconjunctival blepharoplasty with platelet rich plasma. In my practice, we routinely perform this practice procedure under local anesthesia with LITE IV sedation which means that you're not under general anesthesia. We do this sometimes called twilight anesthesia and our patients typically recover and get back to work in less than a week. So my advice to you moving forward is seek out qualified cosmetic surgeons and look for doctors who have a lot of eyelid surgery as well lot of experience with darker skin. And once you're comfortable with the doctor's results looking at their before and after etc., then move forward and take care of the bags under your eyes .So I hope that was helpful and I wish you the best of luck and thank you for your question