Female: Bags and discolored under eye circles. What are my options? Any options for treatment? Thank you.

Dr. Amiya Prasad: Thank you for your question. In your question, you described briefly, eye bags and discolorations, what are your options? Well, as a cosmetic oculofacial plastic surgeon for 20 years practicing in Manhattan in Long Island, this is a question that we get to deal with every day. I'd like to help you by first helping you understand what the causes are of the puffy bags and the discolorations. Unfortunately there are many over-the-counter and other types of remedies, which are claimed to be able to treat bags and discolorations under the eyes, and of course most of them don't really make much of a difference.

We'll start first by understanding the anatomy. Let's start with the puffy bags. Why do you have bags under the eyes? It's typically believed that it's related to lack of sleep, fatigue, etc. When the fat pockets or I should say the puffy bags under the eyes are there constantly, it's due to something called lower eyelid fat prolapse. Lower eyelid fat prolapse means that the fat that's normally around the eyes pushes forward, and in several studies has been shown to actually increase in volume. It results in like a hernia. It pushes forward, creates a bulge and it looks like you're always tired.

The issue there is an anatomic issue. When you have lower eyelid fat prolapse, there is naturally the first line of treatment which is usually getting more sleep and then using some topicals and creams. A lot of our patients come in with a bag full of all kinds of creams, and as I mentioned earlier, they don't really work because the volume that the fat pockets create actually results in a bulge that is deeper than what can be applied on the skin.

We'll discuss addressing that, but before that let's address the discolorations. Dark circles under the eyes is one of the most common complaints and it is understandable. There is a wide spectrum of issues related to dark circles. Sometimes it is due to hereditary, just natural pigmentation that runs in families. It's sometimes due to sun exposure. The skin becomes very thin and wrinkly. In addition, there are other factors such as allergies, where the skin, you can actually see through it and you see the blood vessels and the iron deposits that are due to pooling of the blood. It's often referred to as allergic shiners.

When we talk about dark circles for a light-skinned person with puffy bags under the eyes, we have kind of a global approach to this problem. We begin with first the puffy bags. Typically for a younger person or someone with good quality of muscle tone, and in the absence of extra skin, we have to distinguish that there is a difference between the quality of skin, in other words being thin and stretchy vs. excess skin. We approach this problem typically by doing something called a transconjunctival blepharoplasty. Transconjunctival blepharoplasty is an approach to addressing the puffy bags from behind the eyelid, avoiding any external incision, as well as maintaining the integrity of the anatomy of the lower eyelid. What we do from behind the eyelid is reduce the fat pockets, reposition and other maneuvers in order to just make it look as if the bags were never there.

Now, in terms of the skin quality under the eyes, we have been doing something that a lot of doctors are not doing at this time. This is the use of something called platelet-rich plasma. Platelet-rich plasma is derived from your own blood. It is a process where we draw your blood like you would in a typical lab test situation and we spin it. We spin it to isolate the platelet and the plasma which concentrates the healing factors and the growth factors required for healing. When we inject this material under the skin of the eyelid, it improves the skin quality of the eyelid by improving the vascularity, the collagen and the overall health of the skin.

In addition, in selected cases, we'll also do something called fractional CO2 laser. This is basically using a technology which combines light energy or transfers light energy into heat to take off the top layers of skin selectively and to deliver thermal energy into the skin so there's a tightening effect. When done in combination, the results can be quite dramatic and most importantly they can look very natural.

For a lot of younger people having any kind of incision in a visible area can become very obvious. A lot of our patients really appreciate this approach from the inside of the eyelid. We do this procedure under local anesthesia with light sedation, which is minimal intravenous sedation. We avoid general anesthesia. This way, our patients have a much quicker recovery.


Puffy Eye Bags Causes and Solutions

Dr. Amiya Prasad details the causes of puffy eye bags and how they are removed with precisely performed surgery that leaves no scars or surgical signs. He also details regenerative medicine to treat dark circles.