Baggs and discoloured under eye circles. What are my options? (photo)

Any options for treatment ? Thank you.

Doctor Answers (4)

Lower eyelid bags and dark circle treatment options

+2
From your photo, it appears that the bags under your eyes are caused by protrusion of fat.  The dark circle beneath it is most likely due to shadowing from the puffiness above.  This issue can be treated with surgery, to address the protruding fat, or sometimes a hyaluronic acid filler can be placed under the bags to camouflage them.  The surgical option would be longer lasting than the filler option.  


San Francisco Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

The permanent and natural looking treatment for under eye bags is surgery. Improving skin non-surgically can treat the circles

+1
As a cosmetic oculofacial plastic surgeon for 20 years practicing in Manhattan and Long Island, this is a question that I get to deal with everyday. I'll help you by first helping you understand the causes of the puffy bags and the discolorations. Unfortunately, there are many over-the-counter and other types of remedies which are claimed able to treat bags and discolorations under the eyes, but none of them make much of a difference.

Puffy bags are typically believed to be related to lack of sleep, fatigue, etc. But when the bags are there constantly, it’s due to something called lower eyelid fat prolapse. Lower eyelid fat prolapse means in fat normally around the eyes pushes forward. In several studies, it's shown there is an increase the volume and results like a hernia. There is an anatomic issue involved. Naturally, the first line of treatment is usually getting more sleep and using some topicals and creams. These don’t work because the volume the fat pockets create a bulge that is deeper than what is applied on the skin.

Dark circles under the eyes is one of the most common complaints and it is understandable. There is a wide spectrum of issues related to dark circles. Sometimes it is due to heredity, natural pigmentation that runs in families, or sun exposure. The skin becomes very thin and wrinkly. In addition, there are other factors such as allergies where you can see through the skin and see the blood vessels and iron deposits. This are due to pooling of the blood which are often referred to allergic shiners.

We have a global approach for a light-skinned person with puffy bags under the eyes. For a younger person with good muscle tone and in the absence of extra skin, we have to distinguish the difference between the quality of skin versus excess skin. We approach this problem by doing a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is an approach of addressing the puffy bags from behind the eyelid, avoiding any external incision as well as maintaining the integrity of the anatomy of the lower eyelid. From behind the eyelid, we reduce the fat pockets, reposition and other manoeuvres to make it look as if the bags were never there.

In terms of the skin quality under the eyes, we have been doing something a lot of doctors are not doing yet which is platelet-rich plasma (PRP). Platelet-rich plasma is derived from your blood. It is process where we draw your blood like a typical lab test situation and we spin it. We spin it to isolate the platelets and the plasma which concentrates the healing and growth factors. When we inject this material under the skin of the eyelid, it improves the skin quality of the eyelid by improving the vascularity, collagen production and the overall health of the skin.

In addition, in selected cases, we use fractional CO2 laser. This is a technology which transfers light energy into heat to take off the top layers of the skin selectively and deliver thermal energy into the skin so that there’s a tightening effect. When done in combination, the results can be quite dramatic and most importantly, they look very natural. We do this procedure under local anesthesia with LITE™ sedation which is a minimal intravenous sedation. We avoid general anesthesia so our patients have a quicker recovery.

If someone like you comes to our practice, we would typically do a transconjunctival blepharoplasty combined with platelet-rich plasma injection and possibly the use of a fractional CO2 laser for the skin quality improvement. Typical recovery is about a week. Usually, our patients tend to heal very quickly by avoiding general anesthesia and using local LITE™ sedation.

I think that you should move forward and meet with doctors in person. I can’t stress enough the importance of safety factors of eyelid surgery. This is a very delicate area so you should make sure the doctor you meet is highly experienced and is able to handle the problems that can occur with eyelid surgery. Once you find a doctor that you resonate with, move forward. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 35 reviews

Options for lower eyelid bags!

+1
Hi
I personally don't recommend fillers for your lower eyelid bags. Unfortunately, these days everyone is injecting fillers without really addressing the foundation of your eyelids. Surgery is the best option to address things long term. The new techniques of lower eyelid blepharoplasty don't involve removing fat. Make sure you have an oculoplastic surgeon evaluate you for cosmetic eyelid surgery. I have a link for you to learn more about eyelid surgery. Best of luck.

Kami K. Parsa, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Options for dark eye bags

+1
Hello and thank you for your question.
It appears as though you have excess orbital fat protruding under your eyes. The only way to treat this would be with a lower blepharoplasty. Alternatively, fillers can be used in the hollow area below to camouflage bulging of the fat, but it is just that...camouflage. It doesn't address the problem directly. Further, fillers are temporary and have to be repeated. I recommend that you see a board certified plastic surgeon in consultation to get more specific answers to your questions which can best be addressed after a thorough history and examination is performed.
Best of luck to you!

David Cangello, MD
New York Plastic Surgeon
5.0 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.