The Causes of Eye Bags and Discolored Lower Eyelid Skin, and Treating Both Separately


Thank you for your question. You’re 32-years-old
and you submitted 2 photos. And you describe in your question a concern about how to get
rid of and as well what is the cause of the under eye bags and discoloration. You state
in your question that you’ve had some issues with dehydration and drinking so much but
things have improved over the course of a week and so basically, you are looking for
guidance as to what to do with the under eye bags and the discoloration.
Well, I can certainly give you some guidance as to how I approach people like yourself
who come into our practice. A little bit of background, I’m a Board-certified cosmetic
surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve
been in practice in Manhattan and Long Island for over 20 years. Under eye bags is one of
the most common issues that we deal with and we provide solutions for in our practice for
over 20 years. So, it‘s important for you to understand the cause before you define
the solutions to what you are dealing with. Certainly, the most important issue besides
the underlying cause is of course your general state of health and it’s a duty for me to
at least advise you to also manage and minimize alcohol consumption and anything that causes
dehydration and do things that are best for your general health. I am very much of a proponent
of healthy lifestyle and healthy living and there is nothing that is better for any outcome
for any procedure than a patient who takes care of themselves. Someone who smokes a lot,
doesn’t eat enough, doesn’t sleep well, basically stresses their body. So that point
being made, let’s discuss what the anatomic issues are. To begin with, what causes the puffiness?
Puffiness is caused by something called lower eyelid fat prolapse. Fat prolapse means that
the fat that’s normally around the eyes pushes forward and creates this bulging of
the under eye area that is persistent and you look at yourself and say you look tired.
You look like you haven’t slept. And very often, people will tell us that they are being
constantly asked if they slept enough or if they have been doing drugs or drinking. Essentially,
under eye bags communicates so many things that are not advantageous. Beyond that, discoloration of the skin does
have many different levels. Going from top to bottom, the external element of the skin,
the epidermis to the dermis level is affected by the environment like sun exposure, smoking
or general environment wind and even anything something like eye rubbing or allergies can
have an impact from the outside. In the deeper levels, what is often the case is that when
the skin is very thin, you can actually see through the skin to the underlying structures
such as the blood vessel and the muscle. So when we address patients who have a very
obvious constant puffiness with discoloration, the approach that I generally take is to do
something to reduce the puffiness and that procedure would be lower eyelid transconjunctival
blepharoplasty. What that means is we are addressing the fat pockets that are causing
the bulge from the inside the eyelid. This is done under local anesthesia with LITE™
sedation. From the outside, to deal with the skin quality, we address the skin in two directions.
Under the skin, we treat the skin with a material from your own blood called platelet-rich plasma
(PRP). Platelet-rich plasma (PRP) is a concentration of the wound healing and growth factors so
that the skin which is barely half a millimeter in thickness has some more quality and volume
in terms of collagen and blood supply. From the outside, we can improve the skin quality
with something like a fractional erbium laser or CO2 laser. This helps tighten the skin,
it helps resurface the skin, get new skin to come in and improve the overall appearance.
So this combination approach is very typical. Let’s say you went for a consultation and
it appears you don’t have that much fat prolapse. You have a mild amount and you are
also interested in improving the skin quality. Well then, there is also an option to do this
non-invasively or less invasively and that’s to use fillers such as Restylane or hyaluronic
acid into the area called the tear trough. By placement of filler in the tear trough,
you soften the transition between the under eye bag and the adjacent lower eyelid so that
it doesn’t look as puffy because the puffiness makes the hollow look deeper. You can still
use platelet-rich plasma (PRP) and actually there is a benefit synergistically in improving
skin quality and tissue quality when platelet-rich plasma (PRP) and hyaluronic acid are combined. So there are options for you. There are pluses
and minuses to all of these options but what is important to understand is that you can
make these decisions based on what your unique situations is which require proper examination
and meeting with a doctor who can perform all these procedures. So that, what I would
recommend is meet with qualified, experienced cosmetic surgeons who have a lot of experience
with under eye bags as well as these other modalities and see what you are comfortable
with. Once you figure out what works for you, move forward and take the next step. Again,
there may be some value to taking little steps where you do less invasive procedures first
and then move on to a more definitive procedure, very often, depending on the person’s anatomy
and as well as aging and we will combine procedures. We can do puffiness surgically to reduce under
eye bags, fillers to fill anatomic natural hollows and platelet-rich plasma (PRP) for
skin quality. So it is not just the procedure but it is really the doctor’s approach to
addressing the problem and that is where consultation is very important. So I hope that was helpful, I wish you the
best of luck and thank you for your question.

7 thoughts on “The Causes of Eye Bags and Discolored Lower Eyelid Skin, and Treating Both Separately

  1. sir i have small discolored spot on upper part of eye in the left eye since 1 month is it pigmentation problem how i get rid of it

  2. Sir
    Meri eyes bachpan se e puffy types ha.
    Or ab bhut jyda bad gayi ha..
    Eyes yellowish rahti ha
    Bahut discomfort feel hota ha.
    Plz help me.

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