What is the safest treatment to address puffy/sunken under eyes?

The under eyes are best rejuvenated with surgery in most patients. Fillers can often be used but are not a permanent solution. All interventions carry risk but blindness from any procedure to address the lower lids is extremely uncommon. Best to see an eyelid expert to discuss the best option for you.

The lower lid blepharoplasty procedure is very safe. As a Board Certified and Plastic and Reconstructive Surgeon I routinely perform complete orbital wall reconstructions. Even during that procedure where I am operating under the eye itself blindness is thankfully exceedingly rare (I have never seen it). Therefore during the blepharoplasty procedure where the dissection is limited to the inferior orbital rim the risk for blindness is very low. However, it is very important that you have your procedure performed by a Board Certified Plastic Surgeon. Thank you for your question.

The best treatment for your undereye area depends on your anatomy. If you have puffiness from herniated fat, then a lower blepharoplasty would be the procedure of choice. If you are hollow or sunken, then adding volume from fat grafting or fillers would be more appropriate. Restoring appropriate volume to the cheek is essential too, if the cheek has lost volume. Often people require a combination of treatments (ie, lower blepharoplasty with fat transfer) for optimal results. The risk of blindness from any of these procedures is not zero, but it is very, very, very low. The best way to minimize this risk is to go to someone who has subspecialized knowledge and experience in treating this area, such as an aesthetic fellowship-trained plastic surgeon.

A lower lid blepharoplasty that removed fat pseudoherniation corrects the puffiness. Deep tear troughs below this can be treated with fat transposition or fat grafting with release of the arcus mariginalis

The best procedure to treat this conditions would involve lower lid surgery to reduce the puffy fat, followed by fat injection to fill the hollows. This is a very natural way to address these issues and the result is long lasting. Be sure to see a facial specialist for consultation.

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.

Without a photo of your issue, it is really impossible to address your questions in a meaningful way. Generally eyelid surgery is a very safe surgery with some risk of rare potential complications like almost any cosmetic surgery. I am aware of no treatments around the eye that have zero risk of rare complications. So you want something that truly has a zero risk of even very rare complcations, do to have surgery, laser, or injectable treatments anywhere near the eyes.

Lower Eyelid Blepharoplasty
The lower eyelids look baggy mostly because of excess fat. This can be removed either by making an incision under the lashes called sub-ciliary approach or from inside the eyelid called Transconjunctival approach. The amount of skin removed has to be minimal as it can pull the lower lid downwards and make it look strange and change the shape of the eye. All surgeons have their favorite approaches. I like Transconjunctival approach in most cases.
Regards
Dr. J

The safest treatment to address puffy or sunken under eyes depends on various factors, including the underlying cause, your medical history, and individual preferences. Here are some safe and effective options:1. Topical Treatments: Using skincare products containing ingredients like retinol, hyaluronic acid, vitamin C, and caffeine can help improve skin texture, hydration, and reduce puffiness or dark circles. However, topical treatments may have limited effectiveness for significant concerns.2. Injectable Fillers: Hyaluronic acid-based fillers can be injected into the tear trough area to fill hollows, reduce the appearance of dark circles, and improve the overall contour of the under-eye area. This non-surgical option provides immediate results with minimal downtime.3. Platelet-Rich Plasma (PRP) Therapy: PRP involves using the patient's own blood plasma, rich in growth factors, to stimulate collagen production and rejuvenate the under-eye area. It can improve skin texture, reduce puffiness, and enhance skin tone.4. Tear Trough Filler: This specialized filler technique targets the hollows or grooves between the lower eyelid and the cheek (tear trough area), restoring volume and smoothness to the under-eye area.5. Radiofrequency (RF) Microneedling: RF microneedling treatments deliver heat energy into the skin layers, stimulating collagen production and tightening loose skin. This can help improve the appearance of puffy or sunken under eyes over time.6. Surgical Options: For severe cases or when non-invasive treatments are ineffective, surgical procedures such as lower blepharoplasty (eyelid surgery) or fat repositioning may be considered to address puffiness or hollowing under the eyes. However, surgery carries higher risks and longer recovery compared to non-surgical options.It's crucial to consult with a skilled plastic surgeon to determine the most suitable treatment based on your specific concerns, medical history, and desired outcome. They can assess your individual needs and provide recommendations while ensuring safety and efficacy. Additionally, they can discuss potential risks, benefits, and expected results of each treatment option to help you make an informed decision.

Thank you for your question. Although very rare there have been cases of blindness caused by the injection of dermal fillers into the lower eyelid area. Therefore I avoid this procedure.

A very safe effective procedure to remove puffiness of the eyelids and correct dark circles or hollowness underneath the eyelids is a procedure called a transconjunctival lower eyelid blepharoplasty with arcus marginalis release and fat grafting.