What to Do for Puffy Eyes, Dark Circles, and Under Eye Hollowing


I want to know what I can do to make eyes
look fresh and young? The hollowness and half circle really bother me. My eyes always look tired. I try my best to
hide the problem with makeup but it still shows. They are hollow and simply do not look
like the eyes of a 33 year old. I have excess skin that makes a half circle from the top
of my lid coming to the sides of the nose and under my eye. Please let me know what
can be done to fix this problem. It is really disappointing every time I look in the mirror.
I want to be able to go outside without make up but can’t because of my eyes. PLEASE HELP! Thank you for your question! You’re 33 years old and you described in
a lot in detail your tired-looking eyes and how even with make-up, they still look tired.
You described some half circle of skin that extends to your nose to the upper eyelids
and the hollows of your lower eyelids. You submitted two photos that are very useful
and certainly gives me a good sense of your current appearance. I’m a cosmetic oculofacial plastic surgeon.
I specialize in eyelid surgery, face lifting surgery and so, rejuvenating tired-looking
eyes is pretty much what I do every day. So, when someone like yourself comes to us, we
first try to learn a little bit about why your eyes look so tired. There are the anatomic
issues that we will address in a moment but I would want to also know, are you a smoker?
People who smoke tend accelerate the aging process. Smoking is incredibly destructive
to fine delicate tissue in the body. Do you have seasonal allergies or are you rubbing
your eyes a lot? Are you under a lot of stress? So putting the systemic issues as one contributing
factor and maybe figuring a way to manage that, if you’re a smoker, then stop smoking
clearly is to your advantage. The other parts of it have to do with lifestyle- sleeping
enough, diet and exercise. Basically things that are good for your heart and lungs are
also good for your face and your eyes. Now with those things put aside and let’s
say all those things are the right or fine. You sleep enough, you exercise and you don’t
smoke and you have no issues with allergies, then most likely what you’re dealing with
is a genetic issue. So, let’s start with what is the dominant
issue from my perspective. To me, the under eye area really communicates the tiredness.
For years, we always hear our patients “I’m tired of looking tired.” And so, the puffiness
under the eyes is the most significant issue. Now that doesn’t mean that the hollowing
below the puffiness is not significant. But when you think about the hierarchy of issues
that are contributing to the tired look, I would say that puffiness is on top. So what
is the puffiness? The puffiness is something called lower eyelid fat prolapse. Lower eyelid
fat prolapse means that the fat that is normally around the eyes pushes forward and creates
these bulges. Now these bulges results in a constant look of fatigue. And even if use
creams and you mentioned make-up or other types of non-surgical modalities, they simply
won’t work. In our practice, a patient like yourself would
be treated with a transconjunctival blepharoplasty. This is a method of addressing the fat pockets
from the inside of the eyelid and this way, we are able to avoid an external scar, no
sign of any procedure done from the outside and no one would know that you used to have
the puffy bags. We also often combine this procedure with modalities such as platelet-rich
plasma which is deriving the key growth factors and healing factors from your blood to stimulate
new collagen and to improve skin quality under the eye. We would also use thermal energy
such as the use of fractional co2 laser to help improve the external skin quality. Chances
are, we would also add to your regimen some topical skin products that basically, you
need a good moisturizer. You need a good sunblock, maybe something for cell turnover such as
a retinol product. Now that being said, other areas of relative
hollowing can be addressed. But I usually defer that after the surgery. I feel like
that when you take away the big negative, it’s changing the architecture enough that
you can look at yourself from a different lens or a different filter and understand
what is your priority from the point on. So I think it’s best that you meet with
qualified experience cosmetic surgeons and learn about your options. When we perform
the surgery, we perform it in our Joint Commission approved facilities within our practices in
Manhattan and Long Island. And we do this under local anesthesia with LITE™ IV sedation.
This means we avoid general anesthesia altogether so our patients are able to recover quickly
and go back to work as early as less than week. So moving forward, meet with doctors, get
some opinions. I know I didn’t address directly the upper eyelid skin. Although from my perspective,
with your eyes open, it doesn’t appear to be that much redundancy to the point where
there’s hooding so in terms of the relative contribution to the fatigue appearance, I
would say focusing on the lower eyelids would be a good way to get the most value especially
when you have limit resources and applying these limited resources strategically. I’m
not making assumptions, I’m always counsel my patients of the wish list what will give
you the best of value of what you want to achieve. So I hope that was helpful, I wish you the
best of luck and thank you for your question!

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