What causes eye bags?

Puffiness under the eyes is one of the most common concerns affecting men and women of all ages and
ethnic backgrounds the retail shelves are full of creams claiming to get rid of under eye bags many
of my patients come in with bags of these creams and other DIY remedies which all fail to deliver
any of the benefits they claimed the social impact of having eye bags can be very significant younger
people who are healthy and energetic are frequently perceived by others as being tired lacking in
sleep and even under the influence of drugs I’ll discuss the different causes of puffy eye bags as
well as treatments including non-surgical and surgical options to help people who i see with eye bags

I’m Dr Amiya Prasad I’m a board-certified cosmetic surgeon and a fellowship-trained oculofacial plastic
and reconstructive surgeon I’ve been practicing in New York City and long island for over 25 years
when people come to see me they often report that they tried everything they could before taking
the big step of coming in to see me they often will say how they were hoping to avoid needing surgery
i say to them although surgery may be appropriate I’m more than happy to help people who are candidates
using non-surgical procedures when appropriate i reassure them that being a surgeon provides a unique
insight that enhances my skills in performing non-surgical procedures puffiness under the eyes can be
seen temporarily due to the lack of sleep from allergies and even salt intake these types of puffiness
are caused by fluid and is subject to lifestyle and environmental factors under eye bags which are
always present are due to an anatomic issue called lower eyelid fat prolapse anatomically speaking fat
pads exist in compartments around the eyes and can shift forward like a hernia the term for this
phenomenon is lower eyelid fat prolapse or herniated fat lower eyelid fat prolapse can be hereditary
such as that many of my patients are younger people in their twenties and they’ve had their puffy eyes
appearance since they were teenagers facial aging changes which are characterized by volume loss
affecting the bones and soft tissues can also be associated with under eye fat packs certain lifestyle
factors like smoking can also contribute to weakening of the delicate tissue around the eyes resulting
in puffy eye bags thyroid eye disease can also cause you to have prominent under eye bags having puffy
bags under the eyes is commonly perceived by others as you looking tired or lacking sleep one of the
most common phrases i hear from my patients who have under eye bags is I’m tired of looking tired it’s
important to recognize that under eye puffiness is often associated with a deficiency in volume below
the eye this means that you can have too much volume pushing forward from lower eyelid fat prolapse
resulting in the appearance of under eye bags and at the same time have hollowing due to the lack of
volume in the bone structure below the under eye bags when i perform an examination of this area for
rejuvenation i look at specific anatomic details one i look at how much the bags under the eyes are
pushing forward two i look at the area of the tear trough and determine if the height of the under eye
bags are more or less than the height of a bone located just in front of the fat pocket called the
anterior lacrimal crest and third i look at the projection of the cheekbone and the area below the under
eye backs strategy for this assessment is to determine if your appearance can be improved non-surgically
with the placement of hyaluronic acid filler or by performing surgical sculpting of the prolapsed fat
pockets or even a combination approach using both surgery and cheek filler let’s look at a situation
where the fat prolapse is minimal and the projection of the anterior lacrimal crest or the bone structure
located towards the inner corner of the eye is at least the same height or higher than the height of the
fat i can precisely place hyaluronic acid filler in a space between the fat and the bone to create a
smoother transition and effectively camouflage the prominence of the fat pocket i perform this procedure
in my exam room and my patient leaves the office with little evidence of having had a cosmetic procedure
i often see people who went to injectors to have filler placed in order to camouflage the under eye bags
and these bags were simply too large to address with filler alone that’s just time and money being wasted
when under eye bags are too prominent to camouflage i recommend a surgical procedure called lower eyelid
blepharoplasty i find that most people i see who are interested in improving their lower eyelids become
familiar with this term through their online research some confusion occurs because surgeons offer different
opinions on the type of surgery and the type of anesthesia that they recommend let’s start with the type of
surgery the most commonly practiced approach to lower eyelid blepharoplasty is with a transcutaneous approach
this means that the surgeon operates on the lower eyelid fat pockets through an incision made below the
eyelashes in order to access the fat pockets the skin and supporting muscle is cut and separated before the fat
pockets are sculpted it’s common for the surgeon performing this type of procedure to remove skin with the
expectation that the wrinkled skin will look tighter afterwards as a specialist in primary cosmetic and
revision eyelid surgery i can attest to the fact that many patients who have surgery performed in this way are
at greater risk for problems such as lower eyelid retraction and ectropion partially due to skin shortage at
a minimum many people who’ve had surgery performed in this fashion report that the shape of their eyes change
in a way that is not characteristic of their original natural appearance they feel their eyes look too rounded
these types of results are due to compromise of the delicate anatomic support structures responsible for retaining
the natural shape of your eyes in addition the removal of skin under the eyes is based on an assumption that
there is excess skin in my experience most people don’t have excess skin but rather have a deficiency in their
skin quality in essence the skin appearance characterized by wrinkles and discolorations is due more to a loss
of skin quality and not an excess of skin quantity in my practice i perform most of my lower eyelid blepharoplasties
using a transconjunctival approach this means i approach the fat pockets to be sculpted from behind the eyelid
thereby avoiding any external incision this approach also allows for the preservation of the delicate structures
supporting the eyelid and maintaining your characteristically natural eye shape this procedure is considered
more specialized and technically advanced the art of performing this surgery isn’t how i sculpt the fat and at
the same time preserve fat so you can look as if you never had under eye packs my patients enjoy a more natural
appearance and not looking tired as they did before in order to improve skin quality i use devices and regenerative
technology for the purpose of refreshing the skin appearance and improving the skin quality through collagen
production i’ll routinely use a combination of lasers such as fractional co2 laser fractional erbium laser or radio frequency
instruments to accomplish this in order to further optimize collagen production and generate new blood supply
to the skin i also use prp or platelet-rich plasma platelet-rich plasma is a concentration of the wound healing
elements in your blood necessary when you have an injury like a simple cut i see a lot of patients who have
significant fat prolapse resulting in very large under eye bags oftentimes the patient is so concerned about
the bags under their eyes that they don’t recognize that the volume loss that was present below the bags as
well as the volume loss also affecting their cheekbones during consultation i’ll often suggest having cheekbone
or cheek enhancement with a long lasting hyaluronic acid filler at the same time of their surgery the technique
i employ is derived from surgical techniques used for placement of silicone cheek implants i use the term
structural volumizing for this as i’m able to create an improvement in volume and definition resulting in a more
youthful appearance with hyaluronic acid fillers this is in contrast to conventional approaches to filler
placement in the cheek area which is generally performed by placing the hyaluronic acid filler just below the
skin this approach ends up creating frequently a stereotypical rounded or pillowy look which is far from youthful
the results from addressing under eye bags as well as enhancing cheekbone appearance can be highly satisfying for
the patient as far as anesthesia is concerned I perform transconjunctival blepharoplasty with local anesthesia and
light iv sedation so many of my patients are comfortable and are able to recover very quickly my patients appreciate
being able to avoid the risks and recovery associated with general anesthesia you’re able to return to work in about
a week with minimal swelling or evidence of surgery as a specialist in cosmetic eyelid surgery i’ve been able to
help my patients with under eye bags improve their appearance non-surgically surgically and as well with the
combination approach since the appearance of your eyes has such a significant impact on how you’re perceived by
other people it’s important for you to understand these basic principles so you can make an informed decision
when you’re ready to take the next step i hope you found this information helpful thank you for your question