What's the best treatment for under eye circles/bags/purple color? (Photo)

Thank you for your question. You submitted two photos and ask about the best treatment for under eye puffiness and the purple color under your eyes. You described that one eye is worse than the other, and occasionally you're asked if you have a black eye.I can assist you with this as a Board-certified cosmetic surgeon and fellowship trained Oculofacial plastic surgeon, practicing in Manhattan and Long Island for over twenty years. Under eye bags is one of the most common issues we deal with in our practice, and I’ll share how we approach people like you who come to our practice. Let’s first understand what the puffiness is, which is something called lower eyelid fat prolapse, Lower eyelid fat prolapse means that the fat that's normally around the eyes pushes forward and creates a bulge that is constantly there. It can be asymmetric, since it's fat underneath the skin, it’s not amenable to topical treatments such as creams..Judging from just your photos you I would do something called a lower eyelid transconjunctival blepharoplasty. This means we address the fat pockets from the inside the eyelid to avoid an external incision. Even with asymmetric bags I can sculpt appropriately to balance out symmetry as best as possible. People often come into our practice complaining of dark under eye circles with purplish or reddish color. First, understand what the layers of skin and tissue are all the way down to the bone level. Starting with the top, the skin can be discolored from sun exposure, genetics, orhereditary effects. It can be also discolored at a deeper because the skin is so transparent or translucent that you can actually see the orbicularis muscle underneath the eyes that has a reddish hue. You can also have allergic shiners, which are the result of chronic venous drainage or congestion in the bottom of the eyelids, so you get what is called hemosiderin staining. There are a lot of reasons for discoloration.In our practice when we perform lower eyelid blepharoplasty, it's very routine to help the skin quality improve using a combination platelet-rich plasma (PRP) derived from your own blood. PRP contains growth factors necessary for wound healing, which adds some collagen and improves quality of the skin so it’s less translucent. In addition we also routinely do something called fractional CO2 laser to improve the skin texture and quality, and also improve some of the fine lines.All these things don’t need to be done at once, as there is an upper limit when you're dealing with very thin (half a millimeter in thickness) eyelid skin. We can definitively treat the puffiness in one procedure, but to get optimal results with the skin we may do PRP treatments once every three to six months depending on how you respond. The laser is usually done just once, and sometimes add some topical treatments with more active ingredients such as various retinols. We have our own skincare line in our practice that are customized to help our patients look better.You should meet with qualified, experienced cosmetic surgeons who do a lot of eyelid surgery, and learn about these options. It's important that you are comfortable with your doctor. In my practice, I perform my procedures under local anesthesia with LITE ® sedation as opposed to general anesthesia so patients heal faster, recover faster, and feel better after surgery. We do our procedures in our own office operating facilities in both Manhattan and Long Island that are certified by the Joint Commission. This is a more comfortable environment than a hospital or surgery center, which is important for a lot of patients.I hope that was helpful. I wish you the best of luck. Thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Thank you for the question and sharing your photos. If there are bags in the lower eyelids, then fillers might be the right choice. If the bags are too big, then blepharoplasty with fat transfer would be the right choice. If your lower eyelids are dark because of thin skin allowing the underlying blood vessels to be seen, then there is no good solution. Make an appointment for in office evaluation with an experienced surgeon. Good luck. 

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately.  All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.