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What treatment/procedure can I have to reduce my dark circles and slight puffiness under
my eyes?
I am a 28 year old woman and I am starting to notice that I am forming purplish bluish
dark circles under my eyes and it makes me look tired. I'm tired of using concealer to
mask my darkness, because while it covers my dark circles it makes my puffiness more
exasperated. I've used just about every kind of skin care regimen for under eye puffiness
and darkness but they don't work. I just want to find something that will deal with my concerns
and make me look refreshed
Doctor:
Thank you for your question!
You submitted a question with some photos. At the age of 28 and you described in your
question that there is some frustration you have with the puffiness under your eyes and
the difficulty of using make-up to cover-up the puffiness because the make-up exaggerates
the puffiness. In addition, you also submitted a question about issues about discoloration
under the eyes.
As a cosmetic oculofacial plastic surgeon, spending approximately 20 years dealing with
these kind of issues, I can certainly share with you my perspective as to how we deal
with these types of combined complex issues in our practice. Let's define what is causing
the puffiness under the eyes.
Puffiness under the eyes is called lower eyelid fat prolapse. Lower eyelid fat prolapse is
essentially the presence of normal anatomy where the fatty pockets around the eyes actually
pushes forward and creates a bulge under the eyes resulting in this puffy appearance. Now
typically, people will assume that this is result of fatigue, allergy or other factors
like lack of sleep and will do things such as topical treatment like creams that they
buy over-the-counter and invariably, that stuff doesn't work and then they see a professional's
help. Lower eyelid fat prolapse is a specific volume of fat that really cant be addressed
with topical cream.
At the same time, you also have an issue about discoloration under the eyes. I'll share with
you my approach with that situation. When we deal with discoloration under the eyes,
we first define what is a normal pigmentation that is genetic. For example, people of Indian,
Arab, African decent will have some form of pigmentation under the eyes that we refer
to as dark circles. There are times however that those dark circles look even darker when
there is a loss of volume and there are external factors such as a sun exposure. The eyelid
skin is very delicate so when we deal with this very fine skin that is half a millimeter
thickness, a lot of things can really prematurely affect the quality of the skin. For example,
smoking. A lot of people who smoke, the skin quality of the eyes looks almost gray or ashened.
With that understanding, from your holistic approach, you can modify your habits to try
to protect the skin and maximize its quality just from your own habits of diet, exercise
and things that are good for your heart and good for your skin.
Dealing with the puffiness, what I would typically do for someone like yourself, and this is
limited because I'm using the photos without seeing in actual consultation. When I look
at someone, if there's a slight degree of fat prolapse then we can very often improve
the appearance by using a filler to treat the hollow adjacent the fat to make the fat
less obvious or less of a bulge. In most cases scenarios, by the a person comes to seek attention,
we end having to deal with the fat prolapse with a more definitive method. That's a procedure,
for someone in your age group, we would typically do a transconjunctival blepharoplasty. Transconjunctival
blepharoplasty means that we address the fat pockets from the inside of the eyelid. This
way there's no external scar and we are able to reduce or reposition as appropriate. It
is a surgery and is done in our practice in local anesthesia with LITE IV sedation. It's
relatively minimally invasive from that perspective in contrast from doing it in general anesthesia.
And we are able to address the fat pockets definitively for a long period of time. That's
the nice thing about surgical solution is that a lot of times, people will try non-surgical
solutions but they'll keep having to maintain them and as an alternative, a procedure like
this is more definitive. This is a matter of making sure if this is appropriate for
you by proper physical exam.
Discoloration under the eyes, the skin quality, we have been doing a lot of work with something
called platelet-rich plasma. Platelet-rich plasma is the use of your own blood and healing
and growth factors that are part of your plan that is separated. What we do is we literally
use your own blood to improve the circulation, the collagen and the skin quality. We've had
a lot of really nice results in doing that to help people with discolorations and dark
circles.
When there is a hollowness issue, we have been able to combine the platelet-rich plasma
with a hyaluronic acid filler such as Restylane and we know from literature that there is
a synergistic benefit of combining platelet-rich plasma with hyaluronic acid to actually get
more permanent or long-term benefit of the tissue underneath the skin. So I contract
to using filler alone where the synergy of PRP or platelet-rich plasma stimulates new
blood vessel growth. Stimulates new collagen and hyaluronic acid basically acts like a
scaffold to allow this new tissue growth to occur.
Every patient has to be treated as an individual. So we always customize the plan. If you were
to go for lower eyelid blepharoplasty, very often we would combine with platelet-rich
plasma. We would look at you afterwards and then decide, do we want to treat the hollowness
if there is any. If we do, then that PRP hyaluronic acid has certainly been successful.
At this point, I would recommend that you meet with qualified specialists in cosmetic
eyelid surgery who have a lot of experience with dealing with darker skin and with the
complexities of the different surgical procedures and the type of procedures that are available
to minimize the risk that you would have whether it's surgical or non-surgical. I hope that
was helpful, I wish you the best of luck and thank you for your question!