I'm 42 yrs old and have under eyes puffiness and dark circles. What treatment would you recommend? (photos)
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Lower eyelid fat bags and loose skin
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Best treatment for puffiness of lower eyelids
if surgery is not an option, some people can try an old make-up artistss trick: using Preparation H (the hemorrhoid cream) sometimes can tighten up the skin enough to give a temporary improvement.
Lower eyelid surgery for puffy eyes
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Under eyes puffiness and dark circles?
Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservativelyremoving any excess loose skin that may be present, contouring the bulging fat pads, and smoothing the tear troughs with micro-fat grafts or fat repositioning.
Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of each operative procedure would not be in your best surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
Robert Singer, M.D., FACS
Treatment of under eye puffiness
Lower eyelid fat
Lower eyelid fat bags
The causes and separate long-term treatments for puffy eye bags and dark circles under the eyes
There is variability in puffiness of the lower eyelids because the fat pockets are affected by fluid. Fluid may be the response of the body in situations such as allergies and sinus issues where there is some backup of fluid. Sometimes the fluid is caused by food sensitivities. Lack of sleep will also cause puffiness. So the type of puffiness can be about fluid as opposed to volume of the anatomy of fat.
Dark circles under the eyes are typically a combination of genetics, ethnic pigmentation, sun exposure or environment changes, as well as the quality of the skin. The skin can be so thin that you can see through it and see the blood vessels and the muscle underneath. Sometimes in people with cases of allergies, it will be dark called allergic shiners.
In a situation like yours in the absence of a physical examination, we would typically do a transconjunctival blepharoplasty. Transconjunctival blepharoplasty involves the strategic reduction of fat pockets from the inside of the eyelid to avoid an external incision and repositioning and sculpting as appropriate. We also combine this with a concept of platelet-rich plasma (PRP) which is drawn from your own blood to help accelerate the healing the process. When we deal with the dark circles under the eyes, we typically first do platelet-rich plasma treatment under the skin to improve skin quality. We will also combine it with a procedure like fractional CO2 laser. The combination of treating the physical volume as well as the skin quality yields very nice results that our patients appreciate.
The puffiness after the surgery has to do with fluid management. If it is caused by allergies or sinus problems, then they need treatment. If it’s salt intake or other types of food that might cause the fluid to occur, then you might need to be careful about your diet. That being said, the fluid that causes the puffiness to be pronounced rarely ever is the same level as you are experiencing now.
At this point, meet with qualified experienced cosmetic surgeons who have a lot of experience with eyelid surgery and who could guide you further. The thing that we can’t do in a discussion like this is a physical examination. Judging the integrity of the lower eyelid tone, the canthal tendon and the skin quality is a 3-dimensional experience so meeting with the doctor is important. I hope that was helpful, I wish you the best of luck, and thank you for your question.
Puffiness and Dark Circle Treatment
There are a number of options that can help. Lower eyelid surgery with fat re-positioning can help move the fullness from the lower eyelid to fill in the hollow of the tear trough. Often you can also give a little cheek elevation as well.
Fillers, either artificial or fat, can be used to fill in the hollow of the tear trough. This will help reduce the dark shadow along the eye socket.
The skin quality can also be improved with laser treatment or chemical peels.
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.