Can swollen, puffy eyes be dealt with non-surgically, or would you recommend that I get blepharoplasty/surgery?

Hi Doctors, I'm in my early 20s and I've been very self conscious of my lower eyelids. They always appear puffy, with prominent purple dark circles under my eyes. I think it is part of my genetics. Both my lower eyelids (and even the upper eyelid of my left eye) is swollen - they seem to stay that way whether awake or asleep. I also get very prominent purple dark circles under my eyes as well. Is there a way to bring down swelling via medication or would you recommend surgery? Thanks

Doctor Answers 6

Treatment of Swollen, Puffy Eyes

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There are essentially two different issues to your question.  The puffiness of your lower eyelids would probably be best treated with a blepharoplasty.  The dark circles are a more difficult issue.  Sometimes there can be a vascular issue that may be addressed with a laser and there can be issues with hyperpigmentation that can be treated with creams.  Often these cannot be completely corrected

Orange County Plastic Surgeon

Lower blepharoplasty vs filller injection

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The answer depends on how much relative puffiness (fat) is present relative to dark circles (hollowness) underneath the puffiness.  If there is more puffiness, then lower blepharoplasty with fat repositioning if the best option (which can be done under local anesthesia).  If there is more hollowness present, then filler injection is the best option.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Possible Blepharoplasty Candidate

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Photographs and an exam will be able to determine if the problem of the bags is actual fatty deposits that need to be removed via blepharoplasty. If these are just hereditary sad pads as we call them then it is a different story which you may treat with fillers.  Best regards, Michael V. Elam, M.D.

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 218 reviews

Puffy eye treatment in the young patient.

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Puffy eye treatment in the young patient is treated with a blepharoplasty if these are true bags. An exam will answer the question. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

There is no substitute for an actual physical examination in person.

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The reason for this is that terms like "swelling," "puffy," and even "prominent purple dark circles" mean different things to different people.  To complicate matters more, the anatomic basis for things that generally appear somewhat similar can actually be very different.  You also chose not to provide a photograph.  

There is a condition seen in young people that does cause puffy lower eyelid from inflammation but this is rare.  More likely you are describing contour issues of the lower eyelid that for your age most likely will be very effectively addressed with hyaluronic acid fillers.  The best of these products for the lower eyelid is Restylane.  

When you are ready, an in person consultation with a very experienced aesthetic oculoplastic surgeon will help you have a clear idea on how to proceed.  Generally diuretics (water pills) are not helpful.  Surgery may be an option but many, many individuals your age are avoiding surgery with the use of fillers.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

True puffy eyes or eye bags require surgical treatment

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Thank you for your question.  True puffy eyes or eye bags are caused by fat beneath the eye pushing forward on the eyelid skin.  This condition requires a surgical treatment called lower blepharoplasty to remove the excess fat and correct the puffiness. 

Dark eyelid skin color is a normal human condition caused by skin that is so thin that the purple color of the muscle beneath shows through the skin.This is very difficult if not impossible to treat.Small blue veins scan be corrected with IPL treatments.

Deep depressions or dark circles can be treated with fat grafting during the course of the lower blepharoplasty.

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.