Under eye puffiness/bags/dark circles, is there anything I can do? (photos)

Question

Hello! I’ve recently began to notice due to I think losing weight and also possibly genetics that my under eye bags are a lot more puffy and dark. No matter how much sleep I get or using ice to depuff and using eye creams; nothing helps with my under eyes. It seems I have a deep tear trough but I do not want filler. Are there any other options?

Alan Gonzalez, MD, FACS · Answer

Hello @Gentle171620, thank you for your question and showing your pictures. The cause of dark circle are mainly for lack of sleep, which leads to dilation of the blood vessels, or by the passage of time. The nasolacrimal furrows are a distinctive feature of the face, their appearance is related to different causes:Tiredness, stress, unhealthy lifestyle habits, excessive consumption of alcohol and tobacco, incorrect iron production, less oxygenation in the tissues, some allergies can congest the blood vessels, loss of fat around the eyes or genetic antecedents. It is important to develop a non surgical protocol that fits your possibilities, to fulfill your wishes for improvement and to take into account what can actually be achieved with out fillers. Is best if consult one or several board certified plastic surgeon for more information and recommendations. Best wishes! Alan Gonzalez MD, FACS.

Nima Shemirani, MD · Answer

Hi @Gentle171620! Thank you for sending your photos. The surgical option would be a lower blepharoplasty with fat transposition. A non-surgical approach would be hyaluronic acid dermal fillers. Best of luck to you!

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.

C. Blake Perry, MD · Answer

You would be a candidate for lower lid blepharoplasty with fat transposition. This would take your natural fat from under the eye and move it to the tear trough to give you a smooth transition from the lid to cheek. This is all done through an incision on the back of the eyelid so you would have no scar.
Best to see an eyelid specialist.

Marc Polacco, MD · Answer

Thank you for your question. This is a very common concern. Unfortunately, filler is usually the first-line treatment for this region. A lower blepharoplasty with fat transposition would also be effective but requires surgery and downtime. Those are likely the two best options, and the decision really comes down to your comfort level. All the best.
-Dr. P

Michael I. Echavez, MD · Answer

Just based on your photos, you appear to have some fat that is protruding below your eyes and this is most likely causing the puffiness you see.  Aside from fillers, I would say that surgery is the only other treatment option.  The surgery would be lower eyelid surgery to directly address the protruding fat.

Harold J. Kaplan, MD · Answer

Hello Gentle.  You are a perfect candidate for under eye filler with Restylane.  One syringe should do very well in your situation.

Cory Bovenzi, MD · Answer

The most effective treatment is tear trough filler. However, if you are reticent to that treatment some people with dark undereyes try using hydroquinone pads to help decrease the dark pigment in that area. Based on your photos, it's hard to tell whether this is the case for you as the lighting can change the shadowing around the eye area. If you do in fact have darker pigment under the eyes, hydroquinone can help. While this will not fill the volume defect that filler would, it may lighten the undereye skin to help give you a less "tired" look.

William Portuese, MD · Answer

Photographs demonstrate mild herniation orbital fat creating the puffiness. The best  treatment is a trans-conjunctival approach lower blepharoplasty

Robert Singer, MD · Answer

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary hyaluronic acid fillers like Restylane, long-lasting micro-fat grafts, blepharoplasties to contyour the fat fads, or combinations of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty will produce the best and longest lasting cosmetic result. The darkness may be less obvious, but will not be totally eliminated.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Under eye puffiness/bags/dark circles, is there anything I can do? (photos)

Answers (10)

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