How to prevent eye bags, the short answer
Some eye bags can be prevented and some cannot. Fluid puffiness is prevented by adequate sleep, allergy control, a reduction in salt and alcohol, and a raised pillow. The slow weakening of the orbital septum that allows fat to push forward is driven partly by genetics and age, which cannot be changed, and partly by sun exposure and smoking, which can. Once a fat bag has formed, no habit reverses it. Prevention slows the progression of the bag that is forming, whereas treatment removes the one that is already there.
Dr Gerard Ee consults and performs non-surgical eye bag removal at The Clifford Clinic, 50 Raffles Place, Singapore.
How eye bags form
Behind each lower eyelid sit three fat pads, held back by the orbital septum, a thin fibrous sheet running from the rim of the eye socket to the eyelid. In youth the septum is firm and the fat remains behind it. Two changes occur with age.
The first is that the septum weakens. Collagen and elastin in the septum and the lid skin decline, as they do throughout the face, and the sheet stretches. Fat that was previously held back can now bulge forward against it.
The second is that the fat expands. An MRI study of the orbit across three age groups found the lower periorbital fat area rising from 99 square millimetres in the youngest group to 131 square millimetres in the oldest, with no significant change in the position of the eyeball. The authors concluded that fat expansion is the main age-related contributor to lower eyelid prominence. 1
A third change makes the bag more visible rather than larger. The cheek fat below the eye descends and deflates with age, so the groove between the bag and the cheek deepens and the bag casts a longer shadow. 2
An eye bag is therefore fat pushing forward through a weakened septum, made more obvious by a descended cheek. Each of those three components has a different answer to the question of prevention.
What causes eye bags earlier in some people
Genetics is the first. Some families develop fat bags in their twenties, because the septum is thinner or the fat pads larger from the outset, and no habit alters that. In a Korean analysis of 108 patients presenting for lower eyelid surgery, fat prolapse was the leading finding across the age range and not only in older patients. 3
Sun exposure is the second. Ultraviolet light activates the enzymes that break down collagen and elastin, and the thin lower eyelid skin loses both faster than anywhere else on the face. A looser skin envelope reveals a bag that firmer skin would hold flat.
Smoking is the third, because nicotine constricts the small vessels that supply the skin and the chemicals in smoke accelerate the breakdown of collagen. In a study of 79 pairs of identical twins with different smoking histories, the smoking twin scored worse for lower lid bags, upper lid skin redundancy and malar bags, and the difference was visible after five or more years of smoking. 4
Allergy is the fourth. Chronic allergic rhinitis keeps the lower lids congested and prompts eye rubbing, and repeated rubbing stretches the thin lid skin over time.
Weight is the fifth. Weight gain enlarges the orbital fat and the cheek fat around it, whereas weight loss does not reliably reduce orbital fat once it has expanded.
How to prevent eye bags, what slows them
Daily sun protection is the most effective. A broad-spectrum sunscreen applied to the lower eyelids and sunglasses worn outdoors protect the skin and septum from the main environmental driver, and this is the one habit that alters the structural timeline.
Not smoking is the second. The twin study quantifies the effect, with five years of smoking sufficient to produce a visible difference in the lower lids. 4
Allergy control is the third. Treating rhinitis removes both the congestion and the rubbing.
Sleep and head position prevent fluid puffiness, which is the one form of eye bag that can be prevented entirely, and my article on getting rid of fluid puffiness covers the home measures in full.
Moderation in salt and alcohol prevents the overnight fluid load that both place on the lower lid.
A stable weight avoids enlarging the fat that is already present.
Early treatment of a small bag extends the result. Treating a Grade 1 to 2 fat bag, a small to moderate bulge on the severity scale I use at examination, before the septum has stretched further gives a longer-lasting result, because a septum that still restrains its remaining fat has less to release later. In my own patients, those who hold a result longest are the ones treated early, while the skin is still firm.
What makes no difference to preventing eye bags
Eye creams hydrate the skin and can thicken it slightly, but they do not reach the septum or the fat. My article on eye creams and cold compresses for eye bags covers what they can and cannot do.
Facial exercises work the muscle in front of the fat, and repeated squeezing of the lower lid, if anything, stretches the skin further.
Eye massage and rollers move fluid for an hour. They do not move fat and do not strengthen the septum.
Sleeping on the back prevents fluid pooling, which is worthwhile for a fluid bag, and has no effect on the fat.
No study has shown that an oral collagen supplement firms the orbital septum.
Why some eye bags cannot be prevented, and what to do instead
A fat bag that has already formed is not a prevention problem. The septum does not tighten again and the fat does not shrink on its own. The habits above slow the progression of the bag and prevent fluid being added on top of it, which is worthwhile, but the bag itself requires a treatment that reaches the fat.
For a mild to moderate fat bag with firm skin, non-surgical eye bag removal with AGNES and Secret RF delivers radiofrequency into the fat pad and reduces the bulge, and a published series showed the reduction maintained at 24 weeks. 5 For a large bag or loose skin, scarless eye bag removal removes or repositions the fat directly through an incision on the inside of the eyelid. My review of every eye bag treatment in Singapore sets out how I choose between them, and my article on whether non-surgical eye bag removal is permanent explains what happens to the treated fat over the years.
Related reading on eye bags and under-eye concerns
- Non-surgical eye bag removal: price, what happens and FAQ
- Eye bag treatment in Singapore: every option reviewed
- Is it an eye bag or a tear trough?
- How non-surgical eye bag removal actually works
- How long non-surgical eye bag results last
- When tear trough filler helps and when it does not
- Can eye creams, sleep or cold compresses remove eye bags?
- When dark eye circles are caused by allergic rhinitis
- How dark eye circles are treated
- What Emface Eyes does for the eye area
- Scarless eye bag removal: procedure, recovery and fee
- Eye bag removal cost in Singapore
Dr Gerard Ee, Aesthetic Doctor in Singapore
Dr Gerard Ee is an aesthetic doctor in Singapore and the Medical Director of his practice at 50 Raffles Place. He graduated from St George’s, University of London, trained in surgery at Singapore General Hospital and the National University Hospital, and holds the MRCS (Edinburgh) and a postgraduate diploma in practical dermatology from Cardiff University.
He has practised aesthetic medicine since 2012, is the author of sixteen peer-reviewed papers, and writes and medically reviews every article on this site. Read more about Dr Gerard Ee.
Book a consultation with Dr Gerard Ee at The Clifford Clinic
Dr Gerard Ee consults at The Clifford Clinic, 50 Raffles Place, Singapore. Consultations are by appointment. Message the clinic on WhatsApp, or call 6532 2048.
Frequently asked questions about preventing eye bags
At what age do eye bags start?
Fat bags appear from the late twenties in families prone to them and from the forties in most people. The MRI data show lower periorbital fat rising from the thirties, with the largest increase after 55. 1 Fluid puffiness can occur at any age.
Can eye bags be prevented completely?
Fluid puffiness can be prevented completely by removing its causes. Fat bags cannot, because the septum weakens with age and the fat expands regardless of habit. Sun protection and not smoking slow the process, and genetics sets the pace.
Does sleeping position cause eye bags?
Sleeping flat allows fluid to pool in the lower lids overnight, which produces morning puffiness, but it does not cause fat bags. Raising the head on a second pillow reduces the puffiness.
Why do I have eye bags in my twenties?
Eye bags in the twenties are usually genetic, from a thinner septum or larger fat pads from the outset, sometimes with allergy or short sleep adding fluid on top. A bag in the twenties that is the same size morning and evening is a fat bag and responds to the same treatments as one in a fifty-year-old.
Will losing weight prevent eye bags?
Weight gain enlarges orbital fat and cheek fat, so a stable weight helps. Weight loss does not reliably shrink a fat bag that has already formed, and in older patients it can deflate the cheek and make the bag more visible.
Does rubbing my eyes cause eye bags?
Repeated rubbing stretches the thin lower eyelid skin and loosens it over years, and rubbing is usually a sign of untreated allergy, which also adds fluid. Treating the allergy stops both.
Selected references
Sources cited on this page
- Darcy SJ, Miller TA, Goldberg RA, Villablanca JP, Demer JL, Rudkin GH. Magnetic resonance imaging characterization of orbital changes with age and associated contributions to lower eyelid prominence. Plast Reconstr Surg. 2008;121(3):921–929. doi:10.1097/01.prs.0000299379.17949.0a
- Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg. 2007;120(5):1367–1376. doi:10.1097/01.prs.0000279348.09156.c3
- Lee H, Ahn SM, Chang M, Park M, Baek S. Analysis of lower eyelid aging in an Asian population for customized lower eyelid blepharoplasty. J Craniofac Surg. 2014;25(2):348–351. doi:10.1097/01.scs.0000436736.60042.92
- Okada HC, Alleyne B, Varghai K, Kinder K, Guyuron B. Facial changes caused by smoking: a comparison between smoking and nonsmoking identical twins. Plast Reconstr Surg. 2013;132(5):1085–1092. doi:10.1097/PRS.0b013e3182a4c20a
- Shin JW, Park JT, Chae JB, Choi JY, Na JI, Park KC, Huh CH. The efficacy of micro-insulated needle radiofrequency system for the treatment of lower eyelid fat bulging. J Dtsch Dermatol Ges. 2019;17(2):149–156. doi:10.1111/ddg.13736
This page is written from published research and from clinical experience in Singapore since 2012. It is for general education, not medical advice. Whether a treatment suits you, what it may achieve and what it may risk can only be established at a consultation. Dr Gerard Ee is the Medical Director of The Clifford Clinic, a private clinic in Singapore, and treatments discussed on this site are provided commercially.
