As an oculofacial cosmetic surgeon, this is probably the most common question I get every day in my practice. Since puffy eyes and lines under the eyes are among the first things to happen to many people as the first signs of aging, or have hereditary puffiness under the eyes.
Before they come and see us, a lot of our patients try to treat the puffy bags by using over-the-counter creams and lotions that are guaranteed to help. These don't work because the problem, called lower eyelid fat prolapse, happens inside the eyelid so there’s no topical cream that can help that area.
The puffy bags under the eyes are actually fat pockets inside the eyelid that push forward, which is generally a genetic trait. If eye bags run in the family, or there are members of the family who have them, there’s a very good chance that you have them as well. In my 20 years of practice, I’ve actually operated on three generations of the same family many times, so the genetic component is a real factor.
Earlier in my practice, I used to treat the puffy bags as an isolated procedure, but as soon as the bags were gone and the eyelids were healed, patients were concerned about the lines and wrinkles. Now my approach is to first identify the different components under the eyes. So I do lower eyelid surgery or transconjunctival blepharoplasty, where I take out the fat pockets from the inside of the eyelid, and combine that with a procedure that helps the fine lines and wrinkles to comprehensively enhance and rejuvenate the eye area.
We specifically use a fractional CO2 laser that helps stimulate new collagen and restore almost a baby-like smoothness to the skin. We also do something interesting called platelet-rich plasma, which is derived from your own blood like a typical blood draw from a blood test. We concentrate the platelets which the component of the blood important for clotting and healing. This helps with collagen remodeling, building and improving areas such as fine lines and wrinkles. We also use it for acne scars. and in combination with ACell in our hairloss division in our practice. This combination of addressing the puffiness and treating the lines at the same time is an excellent way for our patients to look brighter.
To summarize the recommendations for your concerns, transconjunctival blepharoplasty which means removing the fat bags from under the eyes and combining that with fractional CO2 laser and platelet-rich plasma will be typical approach in my practice. The only thing that I can’t do is a physical exam to understand the quality of your skin and the other anatomic aspects of your eyelid. I hope that was helpful, and thank you for your question.