What is best for under eye bags, blepharoplasty or fillers?

Most likely bleph: Bags under the eyes are due to 2 things: 1. A weakened lower lid septum allows fat to bulge outward 2. Descent of the upper cheek leaves a groove between the cheek and lower lid. Blepharoplasty removes the bulging fat from the lower lid. Fillers fill the defect, making the cheek and lower eyelid more blended. Either can be effective but bleph is more common and fillers will have to be repeated.

See Plastic Surgeon: First see a plastic surgeon > let him/her examine you and advise the treatment - only on rare occasion, i give fillers, usually surgery is my choice. Sometimes, i may prescribe peels and creams.

Need evaluation: The correct response can only be provided after an evaluation. Both procedures may help individually or as a combined procedure. Under eye bags at age 27 may be due to other causes and those should be addressed first before one considers a filler or a surgical procedure.

Blepharoplasty: A blepharoplasty or eyelid surgery reshapes the upper and lower lid skin and fat. The bulging seen in the lower lids is a combination of fat and loose skin. In order to yield a refreshed, wide awake and natural appearance the lids scars are kept to a minimum and the extra fat is meticulously sculpted away. www.artofplasticsurgery.com

Evaluation: Probably blepharoplasty. But fillers can improve things. See a facial plastic surgeon for consultation.

Possibly both: A lower eyelid blepharoplasty can be performed via a transconjunctival approach (inside the eyelid) with fat removal, plus or minus removal of a small amount of skin from the outside. Frequently the blepharoplasty can be optimized with placement of a filler or even fat to restore a more youthful and rejuvenated lower eyelid contour.