I'm 42 yrs old and have under eyes puffiness and dark circles. What treatment would you recommend? (photos)

Hi all! I am 42 years old.I have had puffy eyes and dark circles as far as I remember, but it has become much worse. I am considering eye lid surgery. the only thing is that some times the puffiness becomes much less and my eyes become bigger and nicer and the black line is also easy to cover! ( this doesn't happen very often, maybe once a year for couple of days) If it is a permanent fat under eyes why does it sometimes become less?! If I get the lower eye lid surgery would I still get puffiness? Thanks

Doctor Answers 11

Best treatment for puffiness of lower eyelids

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if puffiness is the only issue, the most likely scenario is that you have fat bags from around the eye protruding out.  the treatment involves making an incision inside the eyelid (not seen outside) and removing the extra fat pads.  this will not affect the color of the skin (dark circles, etc) for the better or for the worse.  to be sure that this is the cause, you would have to consult a board certified surgeon and be examined to be sure.

if surgery is not an option, some people can try an old make-up artistss trick: using Preparation H (the hemorrhoid cream) sometimes can tighten up the skin enough to give a temporary improvement.

Lower eyelid surgery for puffy eyes

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 The primary goal of lower eyelid surgery is to remove the puffiness look. A lower blepharoplasty performed through a trans-conjunctival approach  can remove the herniated 3 fat pads creating the puffy look. The shadow effect from the bags will disappear once the fat pads are removed, however dark circles from the actual skin pigmentation will not  be improved. For many examples, please see the link below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Dark Lines

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You could try different options. Filler is the simplest and cheapest but may it only provide modest improvement. You would benefit from a lower lid blepharoplasty to improve the contour of the lower lid but you should speak to your surgeon about how he/she dose this as removing a lot of fat can lead to a hollow appearance later on. You are best to seek the advice of a local board certified surgeon with experience in these procedures. Kind regards

Under eyes puffiness and dark circles?

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Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties. There is no one best procedure. Each has benefits and drawbacks.

Fillers can help improve the cosmetic appearance but you will get only a temporary and limited improvement with them. A better and long standing correction would be achieved with a blepharoplasty of the lower lids: Conservativelyremoving any excess loose skin that may be present, contouring the bulging fat pads, and smoothing the tear troughs with micro-fat grafts or fat repositioning.

Keep in mind that following advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling your tissue, assessing your desired outcome, taking a full medical history and discussing the pros and cons of each operative procedure would not be in your best surgery. I would suggest that you find a surgeon certified by the American Board of American Plastic Surgery and one who is ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.

Robert Singer, M.D., FACS

La Jolla,California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Treatment of under eye puffiness

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Several options are available to aesthetically improve the lower eyelid - they basically break down in to surgical manipulation (of fat, skin and/or canthal support), percutaneous filling of soft tissue defects (hyaluronic acid, fat), external skin treatment (laser, peel) and a combination of the above.  At a formal consultation you and your surgeon will review your history (dry eye, etc) and your examination (vector from eye to orbital rim, quality of tissue support, presence of ectropion, etc) and at that time your surgeon will be able to discuss options available to you and the pros and cons of each.

Lower eyelid fat

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You have some prolapsed orbital fat in the lower lids which creates a shadow over the tear trough.  This usually worsens with age. You could try some filler in the tear trough which should lighten the appearance of the area.  Or see an oculoplastic surgeon about having a lower eyelid blepharoplasty.  I like to do a fat repositioning surgery to move the fat into the tear trough.  Keeps the lid from getting hollow.

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 reviews

Lower eyelid fat bags

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It appears that your fullness is from lower eye fat protruding or herniating. You would be a good candidate for a lower blepharoplasty procedure and the specifics of the procedure, with respect to the approach would vary depending on your examination. Fillers in the 'dark' areas would also be a possible option, but once again an examination would be needed to determine what results could be obtained. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 105 reviews

The causes and separate long-term treatments for puffy eye bags and dark circles under the eyes

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As a cosmetic oculofacial plastic surgeon for 20 years, I see this type of issue everyday in my practice. The puffiness is caused by something called lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat that is normally around the eyes pushes forward. In some studies, it has been shown to actually increase in volume. When it pushes forward, it creates a bulge-like hernia called herniated fat. The strategy for herniated fat is to do some type of procedure to reduce, sculpt as well as reposition.

There is variability in puffiness of the lower eyelids because the fat pockets are affected by fluid. Fluid may be the response of the body in situations such as allergies and sinus issues where there is some backup of fluid. Sometimes the fluid is caused by food sensitivities. Lack of sleep will also cause puffiness. So the type of puffiness can be about fluid as opposed to volume of the anatomy of fat.

Dark circles under the eyes are typically a combination of genetics, ethnic pigmentation, sun exposure or environment changes, as well as the quality of the skin. The skin can be so thin that you can see through it and see the blood vessels and the muscle underneath. Sometimes in people with cases of allergies, it will be dark called allergic shiners.

In a situation like yours in the absence of a physical examination, we would typically do a transconjunctival blepharoplasty. Transconjunctival blepharoplasty involves the strategic reduction of fat pockets from the inside of the eyelid to avoid an external incision and repositioning and sculpting as appropriate. We also combine this with a concept of platelet-rich plasma (PRP) which is drawn from your own blood to help accelerate the healing the process. When we deal with the dark circles under the eyes, we typically first do platelet-rich plasma treatment under the skin to improve skin quality. We will also combine it with a procedure like fractional CO2 laser. The combination of treating the physical volume as well as the skin quality yields very nice results that our patients appreciate.

The puffiness after the surgery has to do with fluid management. If it is caused by allergies or sinus problems, then they need treatment. If it’s salt intake or other types of food that might cause the fluid to occur, then you might need to be careful about your diet. That being said, the fluid that causes the puffiness to be pronounced rarely ever is the same level as you are experiencing now.

At this point, meet with qualified experienced cosmetic surgeons who have a lot of experience with eyelid surgery and who could guide you further. The thing that we can’t do in a discussion like this is a physical examination. Judging the integrity of the lower eyelid tone, the canthal tendon and the skin quality is a 3-dimensional experience so meeting with the doctor is important. I hope that was helpful, 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

Puffiness and Dark Circle Treatment

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Dark circles and puffiness underneath the eyes is, unfortunately, a problem that becomes more common with aging. There are often a number of factors, including some fullness in the lower lid from fat pads as well as hollowing along the lower eye socket bone, or tear trough.
There are a number of options that can help. Lower eyelid surgery with fat re-positioning can help move the fullness from the lower eyelid to fill in the hollow of the tear trough. Often you can also give a little cheek elevation as well.
Fillers, either artificial or fat, can be used to fill in the hollow of the tear trough. This will help reduce the dark shadow along the eye socket.
The skin quality can also be improved with laser treatment or chemical peels.

Gregory J. Vipond, MD, FRCSC
Inland Empire Facial Plastic Surgeon

Lower eyelid fat bags and loose skin

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It appears from the photos that you have loose skin with protruding fat in the lower eyelids. This should respond very nicely to a lower blepharoplasty procedure which corrects both of those issues. You also appear to have a very prominent orbital crease at the bottom of the eyelid bag. I have found that even with lower eyelid surgery some of this crease can remain. Fat grafting directly in that crease can be extremely effective (even long term) in smoothing out that crease to give a nice smooth cheek/eyelid junction.

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.