Our eyes are our most important facial feature! Unfortunately our eyes are the first area of the face to show signs of aging. Fine lines and crow’s feet can start to show in our late 20’s and early 30’s. Puffy eyes, bags under eyes and dark circles can also appear early.

Aging changes in the skin cause the eyelid skin to lose elasticity and sag. As the eyelid begins to loosen, normal fat that lies beneath the eyeball pushes forward against the lower eyelid and creates a bulge or eye bag or puffy eye. A shadow forms beneath the protruding puffy eyelid and creates a dark circle beneath the lower eyelid.

We inherit our eyelid structure, so if one or both parents have bags under the eyes, then you are prone to develop eye bags.

Prevention

There are many things that make the lower eyelids swell and which accelerate aging changes. Sun exposure is the worst. Wear your sun block! High salt intake (salted popcorn, Chinese food, etc.) causes the fat beneath the lower eyelid to absorb fluid and swell, making puffiness worse. An unhealthy lifestyle that includes tobacco and excess alcohol intake definitely contributes to eye bags and eyelid wrinkles.

Problems with Older Eyelid Rejuvenation Techniques

Very new, improved and safer eyelid rejuvenation techniques have been developed in the past few years to overcome several problems with traditional blepharoplasty, the plastic surgery technique for eyelid rejuvenation.
Newer plastic surgery techniques preserve and reposition eyelid fat rather than removing fat. Older techniques that removed fat often created a hollow eye appearance.

Older blepharoplasty techniques also used an incision below the lower eyelashes made with a scalpel. This technique often led to a weakening of the lower eyelid which changed the beautiful lower eyelid shape. This problem is called an ectropion and creates a sad eyed look or hound dog eye.

Modern Techniques for Removal of Puffy Eyes, Bags under Eyes, and Dark Circles

• Transconjunctival Blepharoplasty-Today, rather than making a visible incision on the outside of the eyelid, surgeons make a tiny incision on the inside pink portion of the lower eyelid-the conjunctiva. By avoiding the outside incision the support of the lower eyelid is not damaged and the eyelid shape is not changed.

• Fat Repositioning-Instead of removing the fat from the eyelid, the fat is repositioned down lower, on the top of the cheek bone. This maneuver plumps the dark circle and adds youthful fullness to the upper cheek.

• Laser Blepharoplasty-Instead of a scalpel I use a laser to make the tiny incision in the conjunctiva of the lower eyelid. The laser is very precise and accurate and seals blood vessels as the incision is made. There is less bruising with the laser technique.

Act Now

Eyelid rejuvenation techniques to cure puffy eyes work well when you are younger and when puffy eyes, bags under eyes and dark circles are just starting to show. As we grow older and eyelid aging progresses, more permanent changes such as loose skin and wrinkles are harder to correct and may require more complex surgery including skin removal and eyelid tightening called a canthopexy.

Find an Expert

Eyelid plastic surgery is an art. I always recommend consulting two board certified plastic surgeons before you decide. Ask the doctor if eyelids are his/her specialty and how many they have done. Ask to speak to patients who have had eyelid surgery done by the doctor.

See pictures of results of laser removal of puffy eyes, eye bags, and dark circles. Learn how to find a good plastic surgeon read chapter 10 in Save Your Face.

Dr Seckel
Concord, Massachusetts
Boston, Massachusetts

Eye bags and puffy eyes are caused by a structural problem beneath the eyelid, and eye creams just cannot reach the cause of the eye bag or puffy eye and thus cannot correct eye bags or puffy eyes.

Nearly everyone over 30 begins to notice eye bags, puffy eyes and dark circles under their eyes, Billions of dollars are spent each year on skin creams to remove eye bags, puffy eyes and dark circles under the eyes and plastic surgery, called blepharoplasty which is done to remove eye bags and puffy eyes is the third most common plastic surgery operation done in the United States.

What Causes Eye Bags, Puffy Eyes and Dark Circles under the Eyes?

Eye bags, also called eyelid bags, puffy eyes, tired eyes, and dark circles under the eyes, are caused by protrusion or herniation of the fat which lies beneath the eyelid and which normally is held directly beneath the eyeball. The reason the fat is beneath the eyeball is that it acts as a shock absorber preventing the eyeball from coming into contact with the bone of the eye socket. The eyelid is positioned directly over this supporting fat pad and holds the fat in place directly below the eyeball so that the fat can serve its function.

The problem of eye bags and puffy eyes occurs as we age because as the skin of the eyelid ages it loosens, becomes less elastic, and begins to sag and lose tone. As the eyelid loses tone it cannot hold the fat within the bony orbit or eye socket beneath the eyeball, and the fat pushes forward against the undersurface of the weakened eyelid and creates the eye bag , puffy eye, or eyelid bag.

This pushing forward on the eyelid and creating an eye bag, eyelid bag or puffy eye is technically called fatty orbital herniation, because the fat herniates or protrudes from the bony orbit or eye socket and creates a bulge or eye bag or puffy eye. To herniate means to project through an abnormal opening, like the bulge produced by a hernia on the lower abdomen. Eye bags or puffy eyes are a hernia of the eyelid.

The other eyelid aging sign is called dark circles under the eyes. Technically this is called the arcus deformity and is caused by a tethering of the dark circle skin from underneath the eyelid skin by a structure called the arcus marginalis, which is discussed below. The dark circles under the eyes are essentially a shadow created by the overhanging eye bag or puffy eyelid.

How Are Eye Bags and Puffy Eyes Removed Traditionally?

Eye bag removal has traditionally been done with a plastic surgery operation called a blepharoplasty. During the traditional eye bag surgery the plastic surgeon made an incision on the lower eyelid just beneath the eye lashes, exposed the underlying fat causing the eye bag or puffy eye, and removed the fat and also removed some of the skin which had been stretched into the eye bag. Although the blepharoplasty does remove the eye bag or puffiness, there are several problems with this traditional eye bag or puffy eye surgery.

First, the incision through the eyelid weakens the eyelid skin and muscle which supports the eyelid and holds the eyelid tight against the eyeball. As a result of weakening of the support for the eyelid, the eyelid often turns down or sags after a lower eyelid blepharoplasty. Technically this is called an ectropion or scleral show, but in lay terms it is referred to as the sad eyed look or hound dog eyes. It is a terrible stigma of the old scalpel blepharoplasty operation. The ectropion can also have serious implications for the eye ball itself. When the ectropion is severe, the eyeball can dry out, develop a corneal ulceration, and threaten the eye. Often corrective surgery called a canthoplasty is required.

Because of these serious complications from traditional eye bag and puffy eye surgery new modern blepharoplasty techniques have been developed to remove eye bags and puffy eyes without damaging the support of the eyelid. The newer, more modern blepharoplasty technique is called a transconjunctival blepharoplasty. The conjunctiva is the pink part of the lower eyelid on the inside of the lower eyelid, and during the transconjunctival blepharoplasty the incision is made on the inside of the lower eyelid and the fat exposed and the tissues tightened. The transconjunctival blepharoplasty can be used to remove eye bags and puffy eyes without damaging the outer supporting eyelid muscle and tissues and thus the eyelid support remains in tact and there is little risk of ectropion or hound dog eyes after removal of the eye bags and puffy eyes.

Remove Eye Bags but Avoid Hollow Eyes and Correct dark Circles Under The Eyes!

Another serious drawback to traditional blepharoplasty for eye bags and puffy eyes is that often the surgeon removes too much of the fat that was causing the eye bag. The result of too much fat removal during blepharoplasty is that after removal of the eye bag the patient is left with a hollow eye appearance. This is a very distressing problem for patients, so distressing that many patients choose to have additional surgery to transplant fat back into the eyelid to correct the hollow eye appearance after eye bag and puffy eye removal.

Newer more modern blepharoplasty techniques for eye bag and puffy eye correction do not remove fat but reposition the fat or graft the fat into a better position to create a more youthful eyelid look and remove dark circles under the eyes. When a person has eye bags and puffy eyes there is almost always a dark circle under the eye directly below the eye bag. These dark circles are called the naso-jugal fold or tear trough deformity and is caused by the attachment of a small structure called the arcus marginalis. The arcus marginalis is attached to the bone of the eye socket and is also attached to the underside of the lower eyelid just below the eye bag. The arcus marginalis holds the lid down or tethers the lower eyelid to the bone right at the dark circle, creating the tear trough deformity, so the upper part of the lower eyelid, the eye bag falls over the dark circle or tear trough, and makes the dark circle shadow worse.

Newer more modern blepharoplasty involves a transconjunctival blepharoplasty, which avoids ectropion, followed by release of the arcus marginalis, which releases the dark circle or tear trough deformity. Next, the protruding eyelid fat is not removed, but the bulging fat is placed beneath the dark circle, to plump the dark circle or tear trough, reduce the shadow, reduce the eye bag and puffy eye and avoid the hollow eye.

This is a new technique for removal of eye bags, puffy eyes and dark circles under the eyes and not widely practiced by plastic surgeons yet. As always there will be a 10 year delay between this new medical discovery and the adoption of the technique by the majority of surgeons. That is just the way new technology develops in surgery.

Festoons Can Look Worse After Old Style Blepharoplasty for Eye Bags and Puffy Eyes.

A festoon is often mistaken for an eye bag or puffy eye. In fact a festoon is a puffy swelling on the cheek just below the lower eyelid and is not an eye bag or puffy eye as many people think. The festoon is cheek skin and cannot be removed during a blepharoplasty. It is a puffy swelling at the top of the cheek just below the dark circle under the eye just below the eye bag. he technical term for a festoon is a malar bag.

Most people do not understand what a festoon is and mistakenly believe that the festoons can be corrected by the blepharoplasty for eye bags or puffy eyes. In fact, after a blepharoplasty for eye bags or puffy eyes is done, the festoons can look more prominent and make the face look worse!

For many years there was nothing that could be done to remove festoons, however new technology holds promise that we may soon be able to significantly improve festoons. A lateral eyelid /cheek lift can often remove festoons. New laser skin tightening technology may also soon be used to remove festoons.

The Modern Blepharoplasty for Removal of Eye Bags, Puffy Eyes, and Dark Circles Under The Eyes- Transconjunctival laser arcus marginalis release with preservation and repositioning of orbital fat.

I have used the laser exclusively to perform all of my blepharoplasty operations for the past 12 years, over 2300 cases. The new modern way to remove eye bags and puffy eyes is to use the laser to perform a transconjunctival blepharoplasty with arcus marginalis release to release the dark circles under the eyes and correct the tear trough deformity, and fat grafting to plump the dark circle and prevent the hollow eye look. This technique prevents ectropion, sad eyed look, and hound dog eyes and gives the lower eyelid a very young, smooth look with no eye bags and no change in eyelid shape. The results of my experience are published in the Journal Plastic and Reconstructive Surgery. The benefits of using the laser transconjunctival blepharoplasty with Arcus marginalis release and Fat grafting are:

1. No bleeding
2. Minimal bruising
3. quicker recovery
4. No visible scar on the eyelid
5. no change in the beautiful eyelid shape
6. quicker surgery with less anesthesia time
7. Correct the Tear Trough deformity or dark Circle Under the Eye
8. Avoid Hollow Eyes
9. Remove Eye Bags and Puffy Eyes
10. Excellent Results

Add The Lux2940 Fractional Laser Peel of The Lower Eyelid for Eyelid Wrinkle Removal and Total Eyelid Rejuvenation

All blepharoplasty procedures for eye bags and puffy eyes still do not totally rejuvenate the lower eyelid unless something is done to correct the eyelid wrinkles, brown spots, “crêpe” skin and other eyelid aging skin changes. The new Lux2940 Fractional Laser Peel is a revolutionary new eyelid skin peeling technique that removes eyelid wrinkles, sun damage, and aged skin and creates new fresh youthful looking skin on the eyelid. This new ActiveFX peel can be done at the same time as the blepharoplasty so that true eyelid rejuvenation is possible, removal of eye bags, puffy eyes, dark circles under the eyes, and removal of wrinkles and eyelid skin aging changes.

This is the modern approach to eyelid rejuvenation, Total Laser Eyelid Rejuvenation for removal of eye bags, puffy eyes, dark circles under the eyes, eye wrinkles, and sun damage, all with no change in eyelid shape, no hound dog eyes, no sad eyed look, no hollow eyes, all with the help of the laser and the newest most modern eyelid rejuvenation techniques, the laser and the ActiveFX.

To learn more, contact me or read Save Your Face or follow this link.

Dr. Seckel,

Boston, Massachusetts

Concord, Massachusetts

978-369-4499