American Society of Plastic Surgeons
For Medical Professionals

How to get rid of under-eye bags

If you've ever stayed up until the early hours of the morning – be it drinking with friends at your favorite bar or finishing up a presentation for work the next day – you're likely familiar with the unwelcome sight of bags under your eyes. You may have scoured the aisles of Sephora searching for the perfect concealer to hide them or tried some of the more creative home remedies, like putting caffeinated teabags on the area or inverting your body to bring circulation to your face. But as soon as someone gives you a concerned look and asks if you're tired or catching a cold, the struggle once again ensues.

It's not all sleepless nights and stress that bring about under-eye bags though; age and time can also be major culprits. "While there are genetic causes and acquired causes, like allergies, exhaustion and sinus congestion, some people just develop eye bags as they age," says Dr. David Shafer, a board-certified plastic surgeon in New York City and an ASPS member. This is because the three pockets of fat that exist around the eyes (one right next to the nose, one in the center lower lid and one lateral) herniate over time, creating puffy "bags" underneath.

But regardless of whether your under-eye bags are a product of genetics, exhaustion, sinus issues or simply aging, one thing is for sure – you probably would like them gone. Read on to learn all about the treatments and procedures, both surgical and noninvasive, that can help get rid of pesky under-eye bags, as well as which topical ingredients to use and which to avoid.

Surgical solutions

The most effective way to address under-eye bags is with a lower blepharoplasty, a surgical procedure that involves the removal or repositioning of the fat and/or skin underneath the eyes. According to Dr. Richard Ehrlichman, a board-certified plastic surgeon in Boston and an ASPS member, there are two basic approaches to blepharoplasty.

"The first is an external incision just below the lash line cutting through the skin and muscle, going around the eye and elevating this skin-muscle flap to expose the fat pockets, which are then removed," he says. "Another approach is to remove the fat from the inside of the lower lid called a transconjunctival approach." The latter is often preferred since it does not result in an external scar on the lower lid. "Occasionally with this approach, we choose to remove a small pinch of excess skin, leaving the muscle intact and thus there is less chance of deformation or change in shape of lower lid," Dr. Ehrlichman adds.

Nonsurgical solutions

Whether your under-eye bags aren't yet severe enough to warrant surgery or you simply can't face the recovery time and price tag that come with a blepharoplasty, there are still several options available to you.

"Energy-based laser treatments can tighten the skin to help reduce the appearance of the bags," says Dr. Shafer. "These can be a single session or a series of treatments aimed at strengthening the underlying tissue and stimulating new collagen." Look for nonablative resurfacing lasers, like Fraxel, which can be performed by a plastic surgeon.

Dermal filler can also be a solution, though it won't address the under-eye bags directly. "Fillers, like Juvederm, can be injected to fill the hollows in an attempt to decrease the appearance of the bags," Dr. Shafer explains. And while this may work for some patients, it's important to note that it's only a temporary fix. Depending on the filler used, it can last anywhere from three months to a year, so in order to maintain results, you will need to continue injections as needed.

Botox injections in the crow's feet can help address under-eye bags as well, but similarly to laser treatments, they will only address the surrounding skin and won't get rid of the bags themselves. "Botox in the crow's feet can help reduce the tension around the eyes and relax the wrinkles, which can help improve the appearance but will not remove the eye bag," Dr. Shafer says. Like filler, Botox is only temporary and will need to be injected every three to six months to maintain results. It is also important that Botox be injected between the outer edge of the eye and the temple, not along the lower lid, as it could cause the lid to lose its tone and fail to cover the eyeball.

Regardless of which noninvasive treatment you opt for, though, be sure it's with a board-certified plastic surgeon. "Particularly for laser treatments, you need to make sure you are going to a doctor who specializes in treating eyelids," Dr. Shafer says. "Ultimately, none of the treatments are equivalent, and the plastic surgeon must determine which approach is best for you specifically."

At-home solutions

While no topical under-eye products will compare to in-office treatments, they're not without merit. "Under-eye creams and rejuvenating products are very useful," Dr. Shafer notes. "And in addition to the actual bags, discoloration or pigmentation of the skin can make the area look worse."

To tighten skin and reduce the appearance of under-eye bags, the plastic surgeon recommends Alastin's Restorative Eye Treatment and SkinBetter's InterFuse Treatment Cream. To address discoloration around the eyes, he's a fan of Lytera 2.0 Pigment Correcting Serum from SkinMedica. Dr. Ehrlichman says the topical treatment he believes is most effective for reducing the appearance of under-eye bags is Plexaderm, which temporarily tightens the skin and makes the protrusion less noticeable.

In addition to knowing what products will work well for under-eye bags, it's crucial that you know which ones to avoid. "The eyelid skin can be very sensitive, so it's important to not use products unless they are formulated specifically for the eyelids," Dr. Shafer warns. It's also important to apply your topicals delicately, as the skin around the eyes and lids is extremely thin and aggressive application could actually result in skin sagging.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.


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