BonBoz Clinic

Eye Bags and Dark Circles

Under-eye bags occur when the lower eyelids puff out as orbital fat protrudes due to an age-weakened orbital septum, or sagging eyelid skin and muscle. Dark circles are the darkening of the under-eye area caused by hyperpigmentation, visible blood vessels beneath thin skin, or shadowing from the tear trough. These two conditions require distinct treatment approaches: eye bags require fat removal, while shadowing can be improved with tear trough filler.

Medically reviewed by BS.Ths.CKII Nguyễn Xuân Vũ — BonBoz Clinic

What Causes Eye Bags?

Orbital fat is naturally held in place by the orbital septum; with age, this septum weakens, allowing fat to herniate and form bags. Some young individuals develop eye bags due to genetics. Age-related laxity of the skin and orbicularis oculi muscle makes bags more prominent; fluid retention, lack of sleep, and allergies cause temporary puffiness that resembles eye bags but fluctuates from day to day.

What Causes Dark Circles?

Three mechanisms: Pigmentation (darkened periorbital skin due to genetics, eye rubbing, or atopic dermatitis); Vascular (the skin of the lower eyelid is extremely thin, revealing bluish-purple blood vessels that become more pronounced with sleep deprivation); Structural shadowing (deep tear troughs or protruding fat bags cast a shadow underneath, creating the appearance of dark circles even with normal skin pigmentation). Many individuals present with 2–3 overlapping mechanisms simultaneously.

Why Are Eye Creams Often 'Ineffective'?

Because most dark circles in Vietnamese individuals are caused by structural shadowing or vascular issues, not hyperpigmentation—and brightening creams only target pigmentation. When viewed under light from an angle, if the darkness disappears upon gently stretching the skin downward or tilting the head back, it is a structural shadow.

Cause-Specific Treatment Approaches

True fat bags: Lower blepharoplasty (transconjunctival approach leaving no external scar for patients without significant skin laxity, or a subciliary approach combined with excess skin excision when laxity is present). Deep tear troughs: Volumization with HA fillers or autologous fat grafting. Pigmented circles: Gentle topical brightening agents, sun protection, and stopping eye rubbing. Vascular circles: Improving sleep, using mild vasoconstrictive ingredients, or vascular lasers in selected cases. Temporary puffiness: Managing allergies, reducing dietary sodium, and sleeping with the head elevated.

How BonBoz Approaches Your Treatment

A physician conducts an in-person assessment to distinguish true fat bags from temporary puffiness, determine the underlying mechanism of dark circles, and evaluate lower eyelid skin laxity. Based on these findings, we recommend an appropriate treatment plan—which may range from targeted skincare and tear trough rejuvenation to lower blepharoplasty—while clearly explaining the realistic capabilities and limitations of each option.

Severity levels

1

Temporary puffiness

Fluctuates daily, more noticeable in the morning, linked to sleep, salt intake, or allergies. Non-surgical; managed with proper care and addressing the root cause.

2

Mild eye bags, firm skin

Mild fat herniation in younger to middle-aged individuals, with no skin laxity. Can be treated via transconjunctival blepharoplasty with no external incisions.

3

Eye bags + skin laxity

Pronounced fat protrusion with wrinkled, sagging lower eyelid skin. Requires fat removal combined with excess skin excision via an infraciliary (subciliary) incision.

4

Deep tear troughs, shadow effect

Appears dark due to shadowing, not hyperpigmentation. Treated with tear trough fillers or fat grafting; can be combined with eye bag surgery.

When should you see a doctor?

  • Under-eye bags that remain unchanged day-to-day and persist for months are likely fat deposits, not temporary swelling.
  • Dark circles that have not improved despite using various eye creams require identifying the true underlying mechanism.
  • Unilateral eyelid swelling accompanied by pain, redness, or blurred vision requires a medical examination to rule out underlying pathologies.
  • If you are considering tear trough filler injections at a non-physician facility—this area is highly vascular and demands advanced technique as well as complication management expertise.

How BonBoz treats it

Lower Blepharoplasty

Transconjunctival (no external incision) or subciliary approach with skin excision for laxity — performed by plastic surgeons.

Tear Trough Augmentation

HA filler or autologous fat grafting for structural dark circles caused by shadowing; periorbital techniques require a physician.

Learn about this method →

Care for Pigmentary / Vascular Dark Circles

Gentle topicals, sun protection, sleep optimization, and allergy management.

Learn about this method →

Management of Transient Puffiness

Non-interventional; address underlying causes (allergies, high sodium intake, sleep posture).

Learn about this method →

Cost guidance

Costs vary significantly between skincare treatments, tear trough filler (charged per cc), and lower blepharoplasty. The doctor will provide an exact quote after your consultation; estimated price ranges for eye surgery and fillers are available in the cost estimator tool.

The final price follows the doctor’s recommendation after an in-person exam. A confirmed quote has no hidden extras.

Chân dung BS.Ths.CKII Nguyễn Xuân Vũ

BS.Ths.CKII Nguyễn Xuân Vũ

Department of Plastic and Aesthetic Surgery

  • Master of Medicine and Pharmacy — Specialist Level I Surgical Resident, Hue University of Medicine and Pharmacy (2014–2017)
  • Specialist Level II Doctor in Plastic and Aesthetic Surgery
  • Specialist Level I in Plastic and Aesthetic Surgery — Pham Ngoc Thach University of Medicine; Specialist Level II in Healthcare Management — University of Public Health
  • Specialty Certificate in Orthopedics and Traumatology and Certificate in Plastic and Aesthetic Surgery (2017)
  • Medical Practice License No.: 007827/ĐL-CCHN — Issued by Dak Lak Province Department of Health on 04/12/2017
  • Over 15 years of experience, more than 20,000 surgeries
  • Specialist Level II Doctor in Plastic and Aesthetic Surgery at Ho Chi Minh City Hospital of Dermatology (2020–present); previously Lead surgeon for major and minor procedures at Sao Han Hospital (2018–2020)
  • Member of international humanitarian organizations Operation Smile and ReSurge International — performing pro bono reconstructive surgeries for patients with congenital deformities, cleft lip, cleft palate, and ptosis (2022–present)
  • Affiliated with Alcon Pharmaceutical (USA)
  • Member of the Korean College of Cosmetic Surgery (KCCS)
  • Medical Director of BonBoz Clinic
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Frequently asked questions

Can eye bags be eliminated with eye creams or massage?

Temporary puffiness may improve. However, eye bags caused by protruding fat cannot be removed with creams or massage because of their fatty structure; they can only be removed through surgery.

Does lower blepharoplasty leave visible scars?

The transconjunctival approach leaves no external scars, making it ideal for patients with good skin elasticity. When excess skin is present, a subciliary incision just beneath the lower lash line is required, which typically fades over time.

Can fat removal cause a hollowed eye appearance?

It can if too much fat is removed. Therefore, the surgeon will remove a conservative amount and may reposition fat into the tear trough rather than removing it entirely.

Is tear trough filler injection safe?

This area has a rich vascular network and very thin skin. It requires precise technique and appropriate filler selection, performed by a qualified physician to manage any potential complications.

How long do tear trough fillers last?

Hyaluronic acid (HA) fillers typically last 9–18 months, depending on the specific product and individual metabolism. Autologous fat grafting lasts longer, though fat graft survival rates vary from person to person.

Do dark circles caused by lack of sleep disappear with adequate rest?

Vascular dark circles and temporary puffiness do improve with sufficient sleep. However, hyperpigmentation or dark circles caused by structural shadowing will not.

What is the recovery time for eye bag surgery?

Swelling and bruising usually last 1–2 weeks, with full results settling in over 1–3 months. The transconjunctival technique offers a faster recovery than the external incision approach.

Are eye bags in young people a sign of a medical condition?

They are most often hereditary. However, if bilateral puffiness is accompanied by leg swelling or fatigue, tests for kidney or thyroid function are recommended.

Does upper blepharoplasty make lower eye bags more noticeable?

Not directly. However, a rejuvenated upper eyelid can visually make the lower eye bags stand out more, which is why surgeons typically assess the periorbital area as a whole.

Who performs these procedures at BonBoz?

Eye bag surgeries are performed by board-certified Plastic and Reconstructive Surgeons, while tear trough fillers are administered by Aesthetic Dermatologists.

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