Will Eyes by Thermage Help Reduce Puffy, Baggy Eyes?

Question

I am a 27 year old female and have had puffy eyes for as long as I can remember. I get bad allergies in the spring which I believe to be a lot of the cause. However, I have bags all year long (just worse with allergies). I recently visited a dermatologist who said she did not believe I had 'fatty bulges' but more fluid retention and suggested Thermage. I am desperately looking for a procedure other than invasive surgery and I feel that the bags make me look unhappy and old. Is there any proof that Thermage will work for this? Are there any other treatments that will last a long time and be effective?

Anil R. Shah, MD · Answer

Severe allergies, thyroid conditions and a host of other medical conditions can cause excessive swelling around the eyes. This is significant because it means that removal of periorbital fat will not be of benefit. You should first be placed on an aggressive allergy medication and avoidance therapy for several months and not how much improvement can be achieved. Once you have been treated for several months see how much improvement you have achieved. I personally do not advocate Thermage for many reasons and would not recommend its use around the eyes.

Benjamin Caughlin, MD, FACS · Answer

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  So you are right that must people have a multifactorial issue, meaning that there are a few different issues going on. Successful treatment of eye bags requires recognizing this. Thermage can help. I do not think it will make you 100% happy though. It is good as the downtime is little and the risks are smaller than surgery, but the results will also be less.One option that is good for this issue, particularly in young people, is fat transfer to the periorbital area.  This can give great results for patients. Below is a list of some of the most common causes of eye bags. I also included some of the treatments that in my hands get the best results. There are a few videos attached also explaining my treatment process.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. 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. Eczema: 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/or 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

Jason Emer, MD · Answer

There are many things you can do to treat under eye bags, but a combination approach with nonsurgical treatments would give the most improvement: fillers (Belotero, Juvederm Volbella), lasers (Fraxel/CO2), Renuvion (J-Plasma), microneedling/PRP, Cosmelan peels and stem cells. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest getting a formal evaluation with a cosmetic dermatologist to see what is best for you and your goals. Best, Dr. Emer.

Theda C. Kontis, MD · Answer

I have had some nice success camouflaging lower lid bags with fillers. The results can be long lasting, up to a few years in some cases. However, if the bags are really large, filler is not indicated. Thermage will tighten skin, but will not remove the fatty bags. Lower lid surgery is not that bad, and recovery is only about a week. Talk to a skilled surgeon she can go over all your options.

Salvatore Pacella, MD, MBA, FACS · Answer

Thank you for your question.  Results of Thermage are very unpredictable.  More importantly, this can result in damage to the skin of the eyelid through a burn injury.  Most of the time, puffiness is related to fat herniation and NOT retained fluid.  Non-surgical options can be used to treat eye bags.  Oftentimes a dermal
 filler can be injected to smooth the contour of the lower eyelid or 
tear-trough region.  In addition, chemical peels or laser can also be 
used to smooth the texture of skin.  The issue is that these results are
 often not permanent, and over time repeated treatments can be costly.  
Factoring in the cost of a peel and filler every 6 to 8 mos, in about 2 
years, you would have paid for the cost of a permanent fix.Surgery is 
really the gold standard for fixing eye bags.  With minimal invasive 
techniques (such as a trans-conjunctival blepharoplasty), swelling is 
short-lived and downtime can be minimized.  This is certainly worth a 
discussion with your board-certified plastic surgeon who is experienced 
in eye bags treatment.  Bets of luck to you!  Dr. Pacella

Cameron Chesnut, MD, FAAD, FACMS · Answer

Your best bet is going to be seeking out a physician who is comfortable dealing with the periocular region, specifically the puffiness below your eyelids. There is no solid evidence that Thermage is going to do anything to improve your lower eyelid fluid retention.If the puffiness is due solely to allergies, those need to be treated aggressively before any judgments can be made. Sometimes something as simple as just a low salt diet can help reduce that swelling, or edema, of the lower eyelids. To guarantee you're receiving the highest level of care, seek out  a dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties.

Raffy Karamanoukian, MD, FACS · Answer

The number one choice for excessive fullness of the lower eyes is a procedure known as a lower eyelid blepharoplasty. Thermage works well, but is a temporary fix. Raffy Karamanoukian Los Angeles

Brian S. Biesman, MD · Answer

As the person who developed the Eyes by Thermage treatment, I can speak from extensive experience on this topic. Thermage is not a good treatment for puffy bags but, in a minority of patients treated in our initial studies, some reduction of lower eyelid fullness was observed.

Ron Shelton, MD · Answer

Thermage works well for some patients on the loose skin of the upper eyelid but bags of swelling fluid retention on the lower eyelids may not respond well.

Robert W. Sheffield, MD · Answer

That is an interesting question. In mypractice, I do not use Thermage for improving eye bags non-surgically. Iexperienced better results using hyaluronic acid fillers to conceal eye bags.Although the results are temporary, the longevity of the result is still a gooddeal since it can last for about a year. The result looks natural as well. Thatsaid, fillers only work for mild cases of eye bags. I do not use fillers foreye bags, which are large. Other kinds of treatments, possibly surgical innature, may be needed to accommodate large eye bags. Thermage, on the otherhand, works by tightening the skin, but it does not help in removing orimproving eye bags.  I would highly recommend that you visita board certified plastic surgeon who could evaluate the severity of your eyebags as well as take into account your desired result. Your surgeon should beable to develop an effective treatment plan after a proper evaluation. Best ofluck!

Will Eyes by Thermage Help Reduce Puffy, Baggy Eyes?

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