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  • Chris Thiagarajah MD

Everything you would want to know about Eyebags….and how to treat them


Everyone hates eyebags. It is the most common cosmetic issue I treat in patients. Common complaints I hear are:

“I hate my eyebags”

“I feel like I look tired all the time”

“Everyone asks me if I haven’t been sleeping well”


So what exactly are eyebags? Eyebags as they are colloquially known are really a combination of three phenomenon that occur under your eyes. The first is pooling of blood from dilated blood vessels. That gives the undereye darkness. Secondly, fat behind the eye can come forward and swell. This gives the eyelid a bulging appearance. Finally, the third component of the eyebag is the tear trough. This is the thin depression under the eyes that separates the eyelid from the cheek. Patients who complain of eyebags really can have any combination of the three components in varying degree. For younger patients it can be completely blood pooling. In patients in their thirties it can be the tear trough with blood pooling. In older patients it can be all three.

What causes eyebags? There are two main causes: Lack of sleep and aging. If you are a 23 year old and pull an all nightery at Coachella, the blood vessels under the eyes dilate and blood pools there resulting in a darker appearance. As you get older and you stay up to catch a redeye back to Denver from a consulting job, the pooled blood also causes fat under the eye to swell so the problem seems magnified.

With time as the tear trough becomes more pronounced as the cheek descends and more fat comes forward and the undereye fat comes forward more, the eyebag becomes more prominent and permanent. Initially patients may notice the eyebag more prominent in the morning but over time it takes longer in the day for it to go away. Eventually it is never gone.

There is also a small percentage of people who have skin discoloration of the lower eyelids which make it dark without any tear trough, puffiness or blood pooling. The only thing that will work for them is makeup or maybe laser.

The reasons people hate eyebags so much is that they convey fatigue, lack of sleep, and general lack of well being. Because they don’t occur in everyone, the presence of them have more negative connotations than something that is universal like grey hair or even a wrinkle.

So what are the treatments for lower eyelid bags?

Makeup and Creams


First thing is that patients can always use makeup to coverup dark undereyes. It can be harder to use makeup to coverup fat or swelling in the undereye. As one can imagine an elevation in the lower eyelid skin from fat will be difficult to cover up with makeup or cream.

The second thing that can be used are things like Plexaderm that have silicates. Silicates when they dry tighten the skin and can help with the appearance of undereye bags. That being said, it is temporary (like makeup) and if it gets in the eye is extremely irritative. On a final note there are

Filler


For a more permanent solution one can try to use filler. There are a myriad of fillers that are available on the market. That being said there are only specific ones that I use for the undereye area. The choice of filler in any area is based on two qualities. First, important is how soft the filler is. Second, is how much water the filler absorbs. Volbella, Restylane, and Beletero are the fillers that are commonly used under the eyes. They have great combinations of low ability to absorb water and swell. Additionally they tend to be soft. I use Volbella because it is the softest and least water absorbing. It is also sold in half cc vials as well which is a cost savings for patients who don’t need a lot of filler to fill in their tear trough. Filler is not a magical treatment. There are patients where filler is not going to work. They may have excessive puffiness of the lower eyelids or skin discoloration which will not be improved with filler. Some of these patients may need surgery. I tell patients to expect a 90% improvement for filler. If the filler is given and is even 1% overdone it can be bumpy and cause swelling. As a result if one aims for 100% improvement, a fair number of those patients will be overfilled and need to filler to be dissolved.

Filler lasts roughly 9 months to a year depending on the product. It is not permanent. Also if one doesn’t like their filler for any reason, it can be dissolved. In terms of frequency of treatment, there tends to be an additive effect so the treatments tend to decrease over time. My wife was treated by me in early 2017. Nine months later I treated her again but I haven’t treated her since. Her undereyes still look good. Of course not everyone is like that but patients tend to spread out treatments over time from what I believe is a more permanent effect.

Surgery

The final treatment for eyebags is surgery. This is also called a blepharoplasty. During this procedure, the fat from the lower eyelid is reposition into the tear trough. Fat is also permanently removed and skin is tightened. Patients who undergo a lower eyelid blepharoplasty can expect for the lower eyelids to improve significantly after surgery. That being said, if they want things to be perfect, they may need to have a small amount of filler added occasionally to keep things super smooth. As a surgeon, we are dependant on patients anatomy, skin quality, and structure of face. Reproducing a procedure on different patients does not lead to the same result. The results will vary based on the individual as well. As one can expect a 35 year old undergoing blepharoplasty will not be the same as a 75 year old. A smoker may expect different results than a non-smoker. It is important to talk to your surgeon as to what are realistic expectations as everyone is different.

Surgery is permanent and the healing process after surgery can take 6 months to complete. Though the results are permanent, no one can stop the aging process. That being said, most patients have surgery just once in their lives. Often the small changes in aging over time are something that doesn’t bother previous blepharoplasty patients. As you can imagine, a small amount of puffiness at 35 is differently viewed by a patient compared to 35 years later at age 70.

Hopefully this is a good guide for undereye bags for patients in Denver. It is important when getting treatment for the eye area, an expert treats you. Not only is it your face but also the eye supplies vision and that is something that should be considered. Cosmetic procedures around the eyes should not be selected solely on cost. I am always surprised that some patients will go somewhere for $9 botox but only give their dog the best dog food. It is your body and face. Think carefully when getting these cosmetic services to think “If things go wrong, is this the person I would want for help?”. Hopefully you choose a qualified well experienced expert physician who can help you get rid of those eyebags. I have found these patients have a step up in confidence and self-esteem once these are improved.


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