What can be done about under eye bags and crepey skin? (Photo)

Hi Sarah, Sorry to hear about your stressful half year.  The changes that occurred between April 2018 to August 2018 should be fully explored before recommending a bunch of procedures.  Any weight loss?  If so, how much weight.Any new diets, or eating regiments? Intermittent fasting, paleo, low carb or no carb to reach a ketotic state to help burn fat.Any other medical symptoms? Hair loss, brittle nails, etc?Any new medications you are taking?  Any eye drops for glaucoma?Any eyelash enhancers such as Latisse? Or over the counter eyelash enhancers like Rapidlash or Lash Boost (by Rodin and Fields)?Any family history of older family members with hollowing of the eyes or sunken eyes? Google Courtney Cox’s Mother for an example.If there is something medically wrong or medication induced which could cause a rapid deterioration of the fat around your eyes, then that should be the first thing to do, before considering any cosmetic facial procedure.  I’m more concerned about fat loss than collagen loss.  If a fat cell shrinks, there is more volume loss from the fat cell shrinking than collagen loss which are the fibers between the fat cell.  If a grape becomes dehydrated, making the skin of the raisin thicker isn’t going to do much to make it look like a grape again.If nothing is wrong, and none of the skin or eyelash products you may be using is causing it to happen, then by all means explore the options to improve the appearance.  If something is causing the problem, it could continue to progress, and if you do anything now, maybe it won’t last very long or not give you an optimal result.In my practice, I get a lot of patients with hollowing around the eyes.  I will go through the questions listed above before going forward with any facial/eyelid procedures.  About 20-30% of the time, I do find a cause for the hollowing.  The simplest and most common cause is the eyelash enhancers.  Latisse is the most well known and is also a prescription medication, but several over the counter eyelash enhancers such as Rapid Lash and Lash Boost have the same side effect profile as Latisse.  Risk of changing iris color, risk of darkening of the skin around the eyes (fat loss), yet if the patient stops using the product the darkening of the skin improves because the fat revolumizes (the grape becoming rehydrated.)  I recently had a patient who I saw for upper eyelid hollow, who listened to me and was willing to give up her Latisse.  In her email, she mentioned that she had a prominent vein around her upper eyelid area, which disappeared as the fat came back.  It was worth the extra time to listen to the patient find out if there was a reversible problem.  As the eyes hollow, the eyes sink into the socket and appear more deep set.  The skin around the upper and lower eyelids appear darker.  The skin can appear crepier, and form more wrinkles and form them more easily.  The upper eyelid can appear to have a small flap of skin on sitting on the upper eyelid which appears to be excess skin, yet when looking at the person’s younger photos, they actually never had that much eyelid showing when they felt they looked better, with more almondy shaped eyes, instead of more rounded eyes.Looking at your April photos, you have the more almondy shaped eyes with a fullness of the brow fat pad.  Your lower eyelid already at the “smile bag” which is not really a true eyebag.  Please Google Aegyo Sal, which is a Korean beauty trend and make up technique being featured on Instagram and YouTube, teaching women how to create the Aegyo Sal fullness under the eye. If a person smiles and has zero evidence of Aegyo Sal it does not look particularly youthful.One critique of your before and after photo, is that your before photo in April is looking more straight, and your August photo is looking more down so you are looking at yourself on your smartphone.  Looking down will change how the upper eyelid brow complex appears relative to looking straight.If you look straight into the camera lens, I suspect the difference between the April and August photo may not be a dramatic as the photos you posted.  Sorry for the diatribe.  I hope some of these additional questions will help more than the answers I gave.If you have any more questions feel free to repost another question.  I believe there is a feature which allows you to link your new question to this question.Best,
Dr. Yang
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Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Dear Sarah,It appears that you have eyebags in these photos from 1) previous sun damage 2) orbicularis contraction when smiling.The orbicularis contraction could be improved with Botox. The sun damage would require some laser treatment to maximally improve the skin quality there.I've had success using ablative lasers to help the skin on the face.I've leave a link below.I hope this was helpful.

Thank you for sharing your question and posting your photograph. Some of the elasticity of your lower eyelid skin is lossed. Treatment with the erbium laser would help to bring it back and give more of a glow to your skin. See an expert eyelid procedures for detailed evaluation and guidance. I hope this helps.Feel better,

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

It is difficult to tell you accurately based on these photos. You may benefit from lower blepharoplasty.

For your situation Botox and Laser resurfacing are the best options.  You don't see to have much excess fat but a bulge related to muscle hypertrophy which Botox can help with.

There is lose skin and fat under eyes. A blepharoplasty is the best solution but for skin crepe like appearance a laser like Resurfx would be very helpful. RegardsDr. J

Sorry to hear about your stressful year! The good news is, you have just the earliest changes happening in your lower lids, and a small amount of focal laser resurfacing could dramatically tighten and improve the quality of that skin without having major changes in your overall appearance. To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.Cameron Chesnut #realself100 Physician 

Fillers are a nice option to help with the under eye area.  It helps to disguise contour irregularities.  Botox can help soften "crow's feet" at the lateral part of the eye.  Lasers can be used to help improve skin tone and texture.  See an expert injector in your area to learn more.  Be sure to use sunscreen every day.