Under-eye fullness is one appearance with several causes. Herniated orbital fat, a tear trough hollow casting a shadow, fluid retention and skin laxity all look alike — and only one of them is actually a bag.
Patients arrive asking how to get rid of eye bags. Often what they have is not a bag at all.
Herniated orbital fat is the true bag: fat that sits behind the eye pushing forward past a weakened orbital septum. It is structural, it does not resolve with sleep, and it does not respond to volume being added.
A tear trough hollow is the opposite problem. The depression sits below normal fullness, and the shadow it casts reads as a bag. Here the fullness above is not excess — the deficit below is what needs addressing.
Fluid retention fluctuates with sleep, salt and the time of day. Skin laxity produces crepe and folding rather than a discrete bulge.
Where the cause is a tear trough hollow, hyaluronic acid placed deep — on or near the periosteum, beneath the orbicularis — restores the deficit. Low-hydrophilicity product matters here, as thin skin shows water retention readily. HA is chosen partly because it is reversible with hyaluronidase.
Where the cause is true herniation, adding volume is the wrong move. Some cases are better addressed by surgical referral, and saying so is part of an honest assessment.
Where the cause is laxity or pigment, energy-based and laser approaches apply instead.
The periorbital region carries real vascular risk. Technique and plane matter more here than almost anywhere on the face.
“Filling a hollow helps a tear trough. Filling over a true herniation makes it worse. Which one you have decides everything that follows.”
Dr Sin YongOn under-eye assessment
Treatment is planned individually, so the cost follows the plan rather than a fixed list. Four things shape it:
A figure quoted before assessment would not reflect your presentation. Cost is set out clearly at consultation, before anything is agreed.
Under-eye fullness has four common causes: herniated orbital fat pushing past a weakened septum, a tear trough hollow whose shadow reads as a bag, fluid retention, and skin laxity. They look similar and are treated differently, so establishing which one is present comes first.
Whether eye bags can be treated without surgery depends on the cause. A tear trough hollow responds to carefully placed volume. Laxity and pigment respond to energy-based and laser approaches. True herniation of orbital fat is structural, and some cases are better served by surgical referral than by injectable treatment.
The infraorbital region carries vascular risk, and the skin is thin. Product choice, injection plane and technique all matter more here than in most areas. Hyaluronic acid is generally preferred because it can be dissolved with hyaluronidase if required. Suitability is assessed in person.
Fluctuation through the day usually points to a fluid component rather than a structural one. Fat herniation and tear trough hollowing do not change overnight. That pattern is useful diagnostic information and is asked about at assessment.
Cost depends on which cause is present, whether more than one applies, and what approach is appropriate. Because the right treatment differs so much between causes, a figure given before assessment would not be meaningful. Pricing is discussed at consultation.
Not necessarily. Dark circles can be pigment, vascular show-through, a shadow cast by a hollow, or thin skin. Volume correction changes the shadow but does not change melanin. The components are separated at assessment and addressed accordingly.
Consultations by appointment at Orchard Road, Singapore.
WhatsApp +65 8023 7170 →