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?
Will Eyes by Thermage Help Reduce Puffy, Baggy Eyes?
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Doctor Answers 16
Treat the Underlying Condition First
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.
Thermage will not correct eye bags
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
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.
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Eye bags, circles, and swellings
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,
I would not suggest Thermage for treatment of puffiness under the eyes
Puffy lower eyelids
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
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
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
I would not think that you would get any reliable result with Thermage of the lower eyelids. You may want to consider Exilis.
Thermage is used to tight loose skin. As we age skin does tend to loose its elasticity. As the skin drops so does the fatty pockets under the eyes, which can cause the appearance of the dark circles. Sometimes even create some of the bags. Thermage is not the best recourse for the under eye bags. Even though it can assist in the tightening of the skin it will not take away the bags under the. Seek consultation of a well experienced Physician, let him/her see your concerns go over the causes as well as go over the best options for your areas of concern.
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.