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Why Lasers or PRP Under Eyes Don’t Work for Puffy Under Eye Bags

People often ask about treating their puffy under eye bags non-surgically with skin rejuvenation treatments like different serums, creams, PRP (platelet-rich plasma); lasers, or other thermal devices like radiofrequency, and high frequency ultrasound (HIFU). While these treatments have the potential to treat lower eyelid skin issues such as wrinkles or discoloration, they are not effective as stand-alone treatments for puffy under eye bags.

I treat puffy eye bags daily in my practice, as well as other lower eyelid skin issues like wrinkles, dark circles under the eyes, revising lower eyelid surgeries originally performed by other doctors, as well as the full range of upper eyelid treatments and surgeries. It’s important to first know the causes of puffy under eye bags.

Lower Eye bags Before and After surgery - male patient
Lower Eye bags Before and After surgery - male patient

What Causes Puffy Eyes?

Puffiness in the lower eyelids can be caused temporarily by allergies, excessive salt consumption, a lack of sleep or fatigue, or sinus problems. The treatments for these types of temporary eye bags are simple: manage allergies, limit salt intake, get more sleep, and treat sinuses. The type of eye bags that I treat in my practice are always visible, whether you have these other conditions or not. The cause of eye bags that are always visible is lower eyelid fat prolapse, which is caused by orbital fat normally around the eyes for cushioning, which has prolapsed or herniated forward, resulting in bulges in the lower eyelids.

PRP VS Fillers for Under Eyes

The skin itself has nothing to do with lower eyelid fat prolapse, so skin treatments cannot treat eye bags. The ways to treat puffy eye bags involve having to go under the skin. For some slight to moderate cases of eye bags, an injectable filler can be placed at the tear trough, which is the relatively hollow space adjacent to the puffiness. By adding volume to the relatively hollow tear trough, the elevation of the puffy eye bag can be camouflaged. Using a filler can’t be applied to all cases of eye bags as adding more volume when there is already protruding fat can make the eye bags even larger, and more prominent.

bags under eyes treatment before and after fillers
under eye filler before and after

What is the Best Treatment for Under Eye Bags?

The most definitive approach to treating eye bags is to sculpt and remove the fat that causes them, which is done with cosmetic lower eyelid surgery, also called lower eyelid blepharoplasty. There are two ways to approach lower eyelid surgery: transcutaneous blepharoplasty, the more commonly practiced procedure where the fat pockets are accessed through an incision in the lower eyelid skin, right below the eyelashes; and transconjunctival blepharoplasty, a more specialized procedure where there is no external skin incision because the fat pockets are accessed from behind the lower eyelid skin.

I prefer the transconjunctival approach for my patients because the lack of an external incision preserves lower eyelid support structures, which includes the eyelid skin itself. With no external incision, results look completely natural, like the patient never had eye bags.

lower eyelid blepharoplasty and cheek fillers before and after
under eye bag surgery and cheek fillers before and after

The transcutaneous approach is more prone to complications because as mentioned, the external incision can compromise the support anatomy, which is often compounded by surgeons often removing lower eyelid skin in an attempt to treat wrinkles. Lower eyelid skin removal most often results in a skin shortage, leaving the eyes looking rounded and pulled down in a condition called lower eyelid retraction. Skin removal can also cause the edges of the lower eyelids to evert or go outward, causing exposure and irritation called ectropion; or invert or curl inward, called entropion. Wrinkles in the lower eyelids are caused by diminished skin quality, not excess skin quantity, so removing skin is unnecessary in treating wrinkles in the lower eyelids.

lower eyelid surgery with fractional laser and PRP under eyes before and after
lower blepharoplasty with fractional laser and PRP under eyes before and after
With that said, skin treatments like PRP, lasers, and other thermal treatments do play a role in the lower eyelids, which can still be performed in addition to treating eye bags. I often use a laser to cauterize the internal incision made when I perform transconjunctival blepharoplasty. I also use lasers in skin rejuvenation to tighten, and resurface lower eyelid skin to treat wrinkles, as well as induce the body to produce collagen to improve skin strength and texture, which are often done at the same time as lower eyelid surgery. The same principles of using heat for skin rejuvenation and tightening are also done with other devices like high frequency ultrasound, but I don’t use these devices in my practice as they have less heat control as my preferred modalities. For patients with darker skin that is prone to hyperpigmentation from laser treatment, a radiofrequency device like Pelleve can be used for skin tightening, and collagen induction to improve the appearance of wrinkles.

Lower Eyelid Surgery and PRP Under Eyes Before and After

eye bag surgery before and after with PRP for under eyes
eye bag surgery with PRP for under eyes before and after
lower eyelid surgery with Pelleve and PRP under eyes before and after treatment
lower eyelid surgery with Pelleve and PRP for under eyes before and after treatment
male eye bags surgery with laser and prp under eyes before and after by Dr Amiya Prasad New York office
male eye bags surgery by Dr Amiya Prasad New York office
before and after male upper and lower eyelid blepharoplasty with fractional CO2 laser and platelet rich plasma PRP under eyes
before and after male upper and lower eyelid blepharoplasty with fractional CO2 laser and platelet rich plasma PRP
lower eyelid blepharoplasty and prp under eyes before and after recovery
lower eyelid surgery and prp under eyes before and after

Platelet-rich plasma (PRP) can also be used in the lower eyelids of any skin type to induce collagen, improve skin quality, enhance skin texture, and thicken thin lower eyelid skin, without using heat. Platelet-rich plasma is derived from a patient’s blood by doing a routine blood draw, and spinning the blood to concentrate the clear, yellow serum. The serum contains platelets, growth factors, and wound healing factors that are normally used to heal cuts. When injected into the skin, PRP can improve skin texture, quality, and thickness unlike any other treatment. These thermal treatments in skin resurfacing can also be used to treat pigment that causes dark circles under the eyes, while other causes of dark circles such as iron deposits, and skin thinness showing the darker anatomy underneath, can be treated with PRP by increasing blood circulation and supply, and by thickening lower eyelid skin.

PRP Under Eyes Treatment Manhattan, NYC and Garden City, Long Island

While skin treatments can’t treat the prolapsed orbital fat that causes eye bags, they can complement eye bags treatment. While sometimes it’s just the puffiness of the lower eyelids that’s the problem, more often there are concurrent lower eyelid issues like wrinkles, dark circles, and discoloration that can be treated by improving skin quality and texture. If you would like specific recommendations for your case, please contact us through our offices or websites for a consultation.

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