What Causes Water Retention Under my Eyes?

Hollow or baggy eyelids are know one to be a challenging diagnostic and therapeutic concept in the world of aesthetic surgery.  Many factors can play a role in developments of bags. Besides a familial risk factor, one should consider individual factors such as sleep and hormonal state, overall body hydration and allergies, skin quality and characteristics. 
Age related changes with loss and descent of the soft tissue around the eye socket contributes to the progression of the issue and often inherent and/or acquired weakness of the orbital septum which is the anatomic barrier that holds up the eye socket fat evolves into the bulging appearance of the eyelid.

Dear Lisa, It appears from your description that you have evidence of fullness in the lower eyelid region and festoons/malar mounds on the cheek as well. These changes can make a person appear tired, sick and older even when they feel fine inside. 
Many people who undergo one factor which can complicate the results from lower eyelid surgery.
Festoons and Malar mounds are a medical condition in which the skin of the lower eyelid becomes significantly damaged, usually by the sun. This damaged skin can result in folds in the lower eyelids and can lead to swollen mounds on the cheeks. They often occur with age and are more common in people with lighter skin types.
Festoons occur in many people seeking lower eyelid rejuvenation and if not corrected at the time that lower lid surgery is performed, the condition can become exacerbated and make the lower eyelids look worse after surgery.
The reason then why many people are dissatisfied after undergoing lower eyelid surgery to improve the appearance of their lower lids is the result of two main issues:
Swelling that occurs in the face after lower eyelid surgery often accumulates in the lower eyelid region and can take a while to resolve.
The subconscious brain constantly looks for balance in a face, and when lower eyelid fullness and festoons exist they are seen to belong together, as both are usually age-related phenomena. When only one is then corrected (usually the lower eyelid bags), the other is seen in even greater contrast.  The subconscious brain then focuses in on this condition and tells the conscious brain the face is out of balance.
Festoons and malar mounds have been a frustration for surgeons for many years. Thanks to the initial work of Dr. Sterling Baker (a person with whom I trained) and my own improvement and refinement on that work over the last decade, I now have a sophisticated, technically-challenging but effective treatment for festoons and malar mounds.
Many people don’t fully understand or recognize the differences between these two conditions. The first difference is in their cause or etiology; festoons are a result of sun-damaged skin on the lower eyelid and on the cheek and are believed to be affected by underlying contrasting muscle forces over the years of a person’s life.
In contrast, lower eyelid bags are due to age-related fat protruding through the skin in the lower eyelid region. New research has shown that fat can grow and atrophy during our lives in asymmetric ways. The growth of fat in the orbit around the eye along with atrophy of fat in the facial regions around the eye, as well as weakness in some of the orbital containing structures, contribute the fullness we see in the lower eyelid with age.
For some individuals, this fat shows up at a very young age and this is believed to a result of genetic changes in the development of the eye area in those individuals.
The second difference is the location on the face where they form. Lower eyelid festoons can be seen primarily on the cheek with some presence in the lower eyelid region.  Lower eyelid bags are located directly below the lower eyelid lashes and are noticed to become more prominent when someone with these bags looks upwards.  Conversely, festoons are minimally affected when a person looks upwards.
The third difference is the feel of these conditions when they are touched. Festoons are squishy and can be made to move side to side. Lower eyelid bags are firmer, deeper in location beneath the skin and can’t be moved easily side to side when touched.
 It is important to understand the differences between these two conditions. The best rejuvenation and most natural results occur when both eyelid bags and festoons are corrected simultaneously.
I'll include some links below.
I hope this was helpful. 

You should definitely have a complete physical and exam by your primary care doctor to make sure that your overall health is fully checked out.  From your description, it appears you may have some medical background, as most patients do not know to call their condition as "malar edema," which is highly technical language.   Once cleared, it would be good to see a board certified plastic surgeon who can fully evaluate the skin, muscle, fat, all of the relevant anatomy.  Good luck!

Thank you for your question! There are many factors that can contribute to the appearance of under-eye bags, such as lack of sleep, body hydration, allergies, skin quality and hormones.
In this particular case, it may be that age is the contributing factor that is contributing to the development of the under-eye bags. As we age, the loss of facial volume and soft tissue becomes more and more apparent, particularly under the eyes. As this occurs, the loss of soft tissue around the eye socket contributes to the development and severity of under-eye bags.

The appearance of under-eye bags can be corrected with a lower lid blepharoplasty and fat transposition for a rejuvenated and youthful appearance.

For more information, consult with an expert facial plastic surgeon about which treatment or procedure may be most beneficial for you. Be sure to view the aesthetic provider’s before and after photos to gain a better sense of the results that have been previously delivered in the past. Thank you for your time. Dr. Kian Karimi

Hi Lisa,
That can be a frustrating problem.  To date, I have never uncovered a health condition that directly correlates with malar edema, and I do not recommend routine testing of any sort to look for an undiagnosed problem for the average patient.  I can imagine there are exceptions to this, but I personally do not encounter them in my practice, with the exception of patients who have undergone complex reconstructive surgeries.
My own mental schema of the lower lid and midface likens the complex to a sponge.  Sponges suck up water, and the movements of the face wring that water out and help move it along into the lymphatic drainage system.  The only approach that I have that works is to tighten every layer of the lower lid / midface complex to improve the effectiveness of the "wringing" of the sponge. I tighten the midface, then the lateral canthal tendon, then the muscles that encircle the eyelid, and finally, the skin.  This does not work all the time, but it does a significant percentage of the time.
The fact that there are so many "solutions" to this problem suggests to me that there are no true high percentage fixes with any of the techniques.
Best regards, 
JDW

Hello, I believe that your edema may be due to three reasons: 1) the connective tissue sheath surrounding the three fat pads within the lower eyelids thins with age, leading to fat herniation and puffy lower eyelids; and 2) the lower eyelid skin becomes less elastic and descends, causing a crepe-y lower eyelid skin appearance and tired look; and 3) it may be due to malar festoons, which look like thickened mounds sitting atop the cheek bones. I would recommend a consultation with an oculoplastic surgeon to help distinguish these three conditions and plan your treatment accordingly. 

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  If anything you could have your thyroid levels and a hemoglobin check. Fortunately this is likely just the result of living life!  Below are some common causes and treatments.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat re-positioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.





2. Ezcema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!





3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.





4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and fat transfer.





It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.





Hope this helps.





Best of luck,





DrC

What people usually (mistakenly) refer to as "water retention under the eyes" is actually fat prolapse. The fat can become more prominent for different reasons. The bags look larger in the morning because they become more swollen as we sleep on our backs. Allergies may also increase the swelling as can some medical conditions. It is best to seek an in-person consultation with your Oculoplatic Surgeon to determine an appropriate treatment plan. I hope you find this helpful.

Thank you for your question. Most times, excessive swelling under the eyes is not caused by fluid retention, but by excess fat which has herniated. these eye bags are collections of fat that usually require surgical removal. Most of the time, in young patients, these bags can be removed through the inside of the eyelid with no scar. I would suggest a consultation with a board-certified plastic surgeon with experience in eyelid rejuvenation. Best of luck, Dr. Pacella

Hi Lisa

I know how frustrating your condition can be.  As stated by the other doctors checking for a familial predisposition should shed some light as to the cause.  However, I have found this problem to be what we as doctors call, multifactorial (many things can lead to it).  You should check with your primary doctor if any medical condition can be adding to the problem (something that would cause you to retain salt). 

As far as treatment options.  Surgery can aggravate the condition and cause more or new fluid retention.  Mechanical compression with tape at night, etc. is very unpredictable if at all helpful.  Some of the more aggressive lasers which remodel the skin and deeper tissue have shown some success - but with prolonged recovery.  I and some colleagues have attempted inserting a metal probe (insulated) to the area and applying heat to shrink and tighten the tissue and reduce fluid.  This is generally benign and has had variable success.

I think a consultation with a specialist is worthwhile so the tissue can be seen and felt.

Best of luck