Eye Puffiness Due to Insomnia for 7 Years? (photo)

Hi, I've had lower eye puffiness for the last 8 years. I think it's due to my insomnia. I've been sleeping more for the last 2 months, regular sleeping schedule and at least 7 hours of sleep. Will my puffiness go away or will I need lower eyelid surgery? I'm 31 now and my bags/insomnia started at 23 years old.

Doctor Answers 12

Bags in a younger woman

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Hi Jujubes, Interesting that you mention your bags; my oldest daughter had these even as a young girl. It is because she has little support for the eyelids from the lower bony structures of the face just below the eyes, (orbits) and less than well developed cheekbones. You may feel puffy in the morning due to lack of sleep. Sinus disease and allergies as well as thyroid conditions play a role but the anatomic limitations of your face are the likely culprit. Your anatomy may make this more obvious than it really is. All of us are puffy when we wake up. There are surgical and non surgical options. In my view, non-surgical (fillers, my preference is a new product called Belotero), is a good treatment for a time with mild to moderate changes but is not going to give a good result if the problem is significant. Surgery may turn out to be more cost effective in the long run too. I am unable to see your whole orbit so it is hard to recommend one or the other so a consultation is the best was to decide. Parenthetically, people in the fashion industry say that a good trick for puffy eyelids is the old formulation of Preperation H. I have no experience with this. Do you have allergies? If so, see a allergy specialist who may prescribe a nasal steroid. If surgery is recomended, I have used the conjunctival approach for years where the incision is located inside the eyelid. I transpose the fat from the lower eyelid into the upper cheek, below the eyelid. Fat grafts, placed in the mid face below the eyelid can also be done in cases to help to create a good balance between the cheek and eyelid too. 

Insomnia or amount of sleep are not likely causes of your puffy eyes. Surgery that is unnoticeable is a permanent treatment

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Puffiness under the eyes despite enough sleep and rest represent something called lower eyelid fat prolapse. This is means that fat that is normally around the eyes pushes forward and creates a bulge. To correct this, you will need some type of surgical procedure.

There are two approaches in treating puffy bags below the eyes:  transcutaneous blepharoplasty in which the incision is made from the outside of the eyelid; the other is transconjunctival blepharoplasty which is done from the inside of the eyelid. Based on your age and the photos you submitted, you would benefit most from the transconjunctival approach because no one would be able to tell that you underwent any surgery. This also creates a dramatic impact on your appearance.

In our practice, eyelid surgeries are done under local anesthesia with LITEā„¢ IV sedation. This spares you from undergoing general anesthesia but still gives you the right amount of sedation and you are also able to recover quickly after surgery. Typically, patients who had eyelid surgery go back to work in a week or even less with very little bruising and swelling. In addition, our procedures are done in our own joint commission approved facilities with the highest level of safety so patients are assured that they get the right kind of care needed.  I hope that was helpful to you, I wish you the best of luck, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Lower eyelid puffiness

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It is unlikely that insomnia would cause the fullness of your lower eyelids (which is fat) with underlying hollowness (tear troughs). It is likely genetic related. There are nonsurgical (fillers) and surgical (lower blepharoplasty) options available.  If it continues to bother you, consider seeing an oculoplastic surgeon.

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

blepharoplasty for lower eyelid puffiness

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 The primary goal of lower eyelid surgery is to remove the puffiness which is caused by herniated fat pads in the lower lids. A trans-conjunctival approachIs used where the incisions are placed on the inside of the lower lids  and a conservative amount of fat is removed. This is performed under a brief general anesthesia. No skin removal is usually needed until patients are over 45.  Please see the link below  to our blepharoplasty photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Congenital bags corrected with lower blepharoplasty.

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Unfortunately, I don't think sleep has too much to do with this appearance, which is probably permanent.  Can be improved with trans conjuctival (no scar) lower eyelid plasty.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Eye Puffiness Due to Insomnia for 7 Years? (photo)

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You need an in person examination to determine if other causes exist. Than either a lower blepharoplasty of fillers might help. 

Best Treatment for Tired Hollows Under the Eyes

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Hi Jujubes (one of my favorite childhood candies!),

The best treatment for your hollowness under your eyes would be the injection of Restylane by an expert.  This is a delicate and unforgiving area so make sure that you choose your injecting physician most carefully!  Glad to hear that you are getting better sleep.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 39 reviews

How you can reduce eye puffiness

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I suspect that your under eye puffiness is more related to your anatomy. It appears from your photo that you have some loss of the soft tissue/fat of your lower eyelid. This natural occurs with time, usually gradually starting in our late 20s or so. This results in more visible lower eyelid fat and a tired appearance.

Sometimes the underlying bone structure in the area can allow this process to start even sooner, though.

A treatment option for this includes a nonsurgical approach such as restylane skin filler which can be done in the office. A more surgical option would be facial fat grafting in which your own fat is transferred from one part of your body to your eyelid region.

You can read more about fat grafting at my web reference link below.

Thomas A. Lamperti, MD
Seattle Facial Plastic Surgeon
4.9 out of 5 stars 22 reviews

Bags and fatigue

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Most likely not insomnia but soft tissue loss of the cheek below the eyes and tear trough.  You can improve this with filler like Restylane or move on to surgery to remove the bags.  You would want to remove the through a "trans-conjunctival" approach behind the eyelids since you have nice skin and want to avoid an incision.  For now I'd recommend Restylane below the eyes and augment the front of the cheek.  Fat transfer is also an option if you have enough to transfer.  I'll ad a link to fat transfer results.  There's an example of a woman very similar to you.

Best of luck

Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Agree that sleeplessness does not cause lower eyelid bags.

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Of course it does not help either.  Before you go off and consult us surgeons, try the simple things: eye cream.  Eye cream is a special facial moisturizer that is especially emollient.  Don't pay too much.  The $300 creams are not more effective than the $30 creams.  This will help.  I disagree with the other doctors posting here regarding the cause of your lower eyelid "bag."  This one does not look like herniated lower eyelid fat.  No this one looks like your own bony rim.  Put your finger on the bump.  If it is hard, there is your answer.  This is important because taking fat out of your eyelid will do absolutely nothing for you.  Instead fill the lower eyelid with filler is the answer.  Don't do this on the cheap.  Find the very best injector in your area.  This is a very fussy service but the results when done well are amazing.

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

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.