Why is my eyes always puffy? Will Derma Rollers, Microneedling, or fat removal from my under eye help?

Question

I am 27, last year I got PRK (lasik), after a few months i started to get swollen eyes and eye bags. My eyes are very dry. I dried different creams, eyedrops, tea bags, I don’t want fillers, i thought about Derma Rollers or microneedling. I even read about the procedure where they take out the fat under your eye, thats very scary. Please help me? I feel so insecure about these bags. I use medication for allergies as well.

Hooman Khorasani, MD · Answer

Thank you for the post. Unfortunately the photograph is somewhat unclear. Eye rejuvenation is best addressed with a multimodal approach.  Fractional ablative lasers can be very useful at tightening the skin, removing fine lines and stimulating collagen production.  Combination with microneedling, PRP and fillers can augment and sustain results.  Please see an eye rejuvenation expert for best results and to devise a plan that is best suited for your lifestyle and goals.  I hope this helps!

Raffy Karamanoukian, MD, FACS · Answer

Dark under eye circles can make you look tired and older than you are. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of injectable fillers, fractional laser, and RF to blend out the eyelid hollowness and tighten the skin. 
Recommended Creams: Melarase Brightening Kit
MelaClenzMelarase AMMelarase PMMelapadsReplenish Retinoid CreamBest, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

Puffy eyes or under eye bags can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella).There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye. 
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression. 
I hope this helps!

Rian A. Maercks, MD · Answer

Dear Johanna,You are not alone, many people are displeased with under eye bags.  These findings are multifactorial, however in most patients the findings are emphasized most by lack of soft tissue volume in the high cheek.  Without this soft tissue, the secondary cause is more visible, herniation of the fat pads areound the eyeball through the septum of the lower lid.  I typically treat patients with findings like your with a technique that I call "Aesthetic Facial Balancing."  I understand you think you don't want fillers, but please understand all filler interventions are not equal and all fillers are not equal.  In this technique I use the body's own fat, hyaluronic acid based fillers, or allograft materials to rebuild the natural periorbital soft tissue of youth which creates a refreshed and beautified appearance and can make the bags disappear.  a lower lid blepharoplasty with fat transposition could help as well but will not correct the volume imbalance and would not be my initial recommendation for you.  I hope this helps!All the best,Rian A. Maercks M.D.

Luis A. Cenedese, MD, FACS · Answer

Lower lid lines are best treated by lower blepharoplasty.  When properly performed bags are decreased and wrinkles improved.  Scars are difficult to detect; deformities are rare.  Results last for years.  
Non surgical options include CO2 LASER and Phenol Peel. One treatment typically produces results lasting for years. Fraxel LASER, Radio-Frequency treatments and micro-needling with PRP or stem cells are good options.  Several treatments are required lasting up to one year.
Puffy eyelids are most often caused by bulging of the fat which supports the eyelids. Certain anatomies of the lower eyelid region predispose young people to this deformity. Loss of volume of the bony infra-orbital rim accentuates this problem in older individuals.
Various options are available. The most successful is injection of filler below the lids and the tear trough.  Hyaluronic acids are most commonly used as they correct the majority of the defect.and last well in this area. The addition of PRP or Stem Cells can help to lighten the skin of the area as well as prolong the duration of correction. Hyaluronic acids can cause a bluish discoloration when injected under the lids. Techniques exist to decrease the probability of this occurring. Over correction with bumps is not rare. These are easily corrected with an injection of Hyaluronidase. Fat injections with their stem cells are more long lasting solutions which in addition correcting the defect help to improve the color and quality of the overlying skin.
Eyelid bags may be successfully diminished by injection of a few solutions. One to a few sessions result in long lasting correction.
Please consult in person with an experienced Board Certified Plastic Surgeon prior to making treatment decisions.

Camille Cash, MD · Answer

You mentioned that you don't want to use fillers, but I think that from a non surgical perspective, that is probably the treatment that will work best for you.  They are used to disguise under eye irregularities and the results last up to one year.  You may see some mild improvement with microneedling or lasers.  I would try fillers before deciding to undergo surgery.

Why is my eyes always puffy? Will Derma Rollers, Microneedling, or fat removal from my under eye help?

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