Puffiness under eyes - what treatment is best? (photos)

Question

I’m unsure what causes the puffiness under my eyes and, therefore, how to treat them as doctors, to date, have been reluctant to treat my eyes with filler. They suspect the area is swollen but for unknown reasons. I have a history of sinusitis and am generally sensitive to pollen, dust etc. But does that mean my eyes are untreatable? My eyes have been puffy for about 4 years (from memory). I need suggestions and recommendations as I would love to see the puffiness gone for once in my life!

Jonathan Kulbersh, MD · Answer

Thank you for providing photos along with your question. There are several treatment options for eye rejuvenation that are generally safe. Fillers, lasers, and other procedures that help collagen production can be very effective. For a surgical and more permanent option, there is lower blepharoplasty which eliminates excess skin or fat under the eyes to reduce the appearance of bags, puffiness, loose skin, or hollowness under the eyes. Lower eyelid surgery rejuvenates the entire face and helps correct the proper contour and function of the eyelids when needed. But the best way to determine the best treatment is to schedule an in-person consultation with a reputable board-certified facial plastic surgeon. Your surgeon can do a proper evaluation, determine your eligibility for any procedure, discuss benefits and risks, and ensure the best possible outcome.

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Robert T. Buchanan, MD (retired) · Answer

Only an in person exam could tell for sure, but you do not appear to have "puffiness," but a variation of the molar ligament that occurs in about 15% of people. If so, this is easily treated with a heavy filler below the ligament on the muscle and/or the bone by a true expert in treating this area. Unfortunately, these are relatively infrequent among the injectors who treat this area. Choose your injector carefully.

Puffiness under eyes - what treatment is best? (photos)

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