What's the cause of my sunken eyes and under eye bags? (Photo)

I've also personally answered your question on a video on YouTube titled, "How to Address Both Sunken Eyes and Puffy Eye Bags with Separate Treatments".My practice has a strong focus on
facial aging. In facial aging, there are two things that happen: volume loss
and there’s descent or sagging. Volume loss can cause hollowing. In terms of
your thyroid hormone levels, you can speak to your medical doctor or internist
and have them check hormonal levels. Thyroid hormones are basically a standard
testing for any general medical workup.



Most patients who come to my practice have volume loss in the
eyelid to cheek area or the submalar area. They also have a little bit of fat
prolapse where there’s a bag pushing forward. When a person has a bag pushing
forward, they think that their face is hollowed because the valley next to the
eye bag is deep. They don’t see how the hollowing relates to the puffiness.



Lower eyelid puffiness that is constant is called lower
eyelid fat prolapse. Paradoxically, you will have volume loss in other areas. You
will also lose bone, muscle, fat and soft tissue around the eyes. Genetically,
you could have a forward movement of fat that is normally around the orbital
space and creates a hernia. We would address this with the most common
procedure which we do in our practice called transconjunctival lower eyelid blepharoplasty.
In this procedure, we go from the inside of the eyelid and sculpt the eyelid
fat so that you don’t have the bulges under your eye.



At the same time, we also inform our patients to be mindful
of the relative volume loss in the eyelid to cheek junction. We can strategize
volume correction based on the patient’s own aesthetic. If they feel that
there’s still some volume loss even if they improved the bagginess under the
eyes, then we’ll address that using Restylane or another hyaluronic acid filler.
We’ll also use platelet-rich plasma which is a product derived from your own
blood. This has healing and growth factors from the cells called platelets and
the plasma that is separated from the red blood cells. This stimulates collagen
formation and blood supply. These are part of the youthful appearance of a vibrant
skin that has substance to it.



I think that besides seeing your medical doctor, you have to rule
out any other metabolic issues. Meet with qualified experienced cosmetic
surgeons because surgeons can do both non-surgical and surgical procedures.
Also, learn about your options for rejuvenation in the eye area and get a sense
of what you’re comfortable with and which doctor you feel would address the
type of issue that’s your highest priority. I hope that was helpful, I wish you
the best of luck, and thank you for question. This personalized
video answer to your question is posted 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.

Hi Yesi.  The issue of the sunken area under the eyes is created as a result of genetics and aging.  It is part of the natural aging process to lose volume in the cheeks and under the eyes and also for the skin and muscle is this area to become less elastic.  These facts can work to make the area look hollow, dark and tired.  Our mainstay when it comes to addressing this issue, especially for patients without a lot of loose skin, is a dermal filler called Restylane.  We have found it to the the best product for this area and it typically lasts about 9-12 months when done well.Find a skilled injector in your area to talk to about Restylane injections under the eye.  In the meantime, take a look at the before and after pictures of Los Angeles based patients that have had Restylane injections under the eye at the link below.

In the photos you provide, you have a volume deficiency in the lower lids.  This will make the area appear dark and hollow.  The fat pads that you do have create more shadowing to further darken the tear trough.  Hypothyroid conditions are not usually responsible for this - it is a normal aging change for some people.  If you add some filler to the tear trough you should be able to smooth out the transition from cheek to lid and decrease the dark circle.