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

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 LITEâ„¢ 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.