Will Eyes by Thermage Help Reduce Puffy, Baggy Eyes?

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?

Doctor Answers 17

Treat the Underlying Condition First

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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.


Chicago Facial Plastic Surgeon
4.8 out of 5 stars 171 reviews

Thermage will not correct eye bags

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Dear KC,

Eye bags, puffy eyes, bags under eyes, and dark circles under the eyes are most often caused by a condition called orbital fatty herniation.

If your bags are constant and not cyclical related to allergic reactions or fluid retention, then fatty orbital herniation is the most likely cause.

Thermage is a skin tightening technique using Infrared energy. It cannot be safely used on the eyelids, and if it is used, can only tighten the skin about 20% and will have NO EFFECT on eye bags (which are caused by protrusion of fat beneath the eyelid skin).

Correction requires repositioning of the protruding fat that is bulging and pushing the lower eyelid skin forward into a bag.

If you have a dark circle or indentation beneath the lower eyelid you may also have the arcus marginalis deformity, which can also be corrected with blepharoplasty.

The most modern techniques involve a transconjunctival approach through the inside pink portion of the lower eyelid. This avoids a visible external incision which can change the shape of your lower eyelid.

Today, we also reposition the fat instead of removing the fat. Fat removal can create a hollow appearance. By repositioning the fat on the cheek bone, the eye bag is removed and the eye and upper cheek area looks more full and youthful.

Please see the links for before and after pictures: Set 1 and Set 2

Thermage for eyelids

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

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Under eye bags, maybe filler but not Thermage

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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.

Eye bags, circles, and swellings

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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

Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

I would not suggest Thermage for treatment of puffiness under the eyes

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Thermage is basically a radiofrequency device that delivers electrical energy to your tissues and creates heat with the expectation that the resultant thermal injury to the tissues will stimulate collagen formation and cause contraction of the tissues.  Aside from the fact that it is very painful, the skin of the eyelids is the thinnest skin in the body and thus at highest risk to have burns and other permanent injuries from such a device, and it is very hard to keep such energy from penetrating either too deeply or not deeply enough in this area (very, very narrow "therapeutic window"), I don't think there is any solid, peer-reviewed data that show that this treatment will do anything to improve swollen, puffy tissues under the eyes.  My opinion about treating things around the eyes that are deeper than the absolute surface of the skin where a laser is best, is that it is best to consult with a board certified plastic surgeon, facial plastic surgeon, or occuloplastic surgeon who has actual experience in operating on this area.  Only they will truly understand the surgical anatomy of the area and be able to recommend a sound plan for addressing your specific problem, whether it is surgical or non-surgical.  If you insist upon undergoing Thermage, at least ask to see photos of a series of patients just like you who have had excellent results from the proposed treatment at the hands of the physician in question before you do.

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon

Puffy lower eyelids

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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.

Treatment for baggy eyes

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It's very important to make sure your allergies are under control before proceeding any further on any type of treatment. Allergies are controlled with a combination of nasal sprays, antihistamines, environmental avoidance and allergy shots when they're quite severe. The fluid retention is present in the lower  eyelids can come from a variety of reasons, so make sure you also try a low-salt diet. Also important to make sure there is no thyroid conditions present.
Once medical management has failed, consideration for a trans-conjunctival( inside the eyelids) approach for conservative removal of fatty deposits in the lower lids under a very brief general anesthetic. Anticipate approximately 10 days bruising and swelling after the procedure.  For many examples, please see the link below  to our  surgical blepharoplasty photo gallery

Treatment of the lower eyelids

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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

Consider Exilis

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I would not think that you would get any reliable result with Thermage of the lower eyelids.  You may want to consider Exilis.  

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.