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.
