Guest Blogger Dr. Irwin – The Cause & Treatments For Dark Eye Circles, Puffy Eyes & Wrinkled Eyelid


Under Eye Circles

Sometimes genetics, weight loss, or even lower-eyelid surgery that takes too much of the fat pad can give the appearance under the eyes of hollowness or gauntness, which most refer to as ‘under eye circles’.

Under eye circles can also be caused by excess pigment or superficial veins, or a combination of several of these factors.

The first thing to do is make sure you are getting enough sleep and enough fluids.  Being dehydrated and sleep-deprived will accentuate any hollowness under the eyes.

Only expert injectors should be working around your eye area if you decide that fillers are your best option for a hollow under eye area! Restylane and Juvederm are the most commonly used. And with all fillers, there is a risk of bruising, swelling, and lumpiness. Fat transfer is an option but expect a longer recovery time and possibly longer lasting or permanent lumpiness.

For dark pigment or visible blood vessels under the eye, consider fractionated CO2 laser resurfacing. More than one treatment may be needed. Healing time for back to work (but not “camera ready”) is 4-7 days.

Juvederm/Restylane are the hyaluronic acids (a natural sugar). The cost is $450 to $600 per syringe and usually only 1 is needed. You will need maintenance treatments every 6-12 months. Experts only. Read more about fillers here:


Sagging or Excess Skin

If the puffiness under the eye is due to excess skin or sagging, there are two things you may want to consider. If the problem is mild, try reducing your salt intake and increasing your water intake to 6-8 glasses a day. Also, stick to foods low on the glycemic scale (no white sugar, soft drinks, alcohol, white flour, etc.).

See if there are allergies that are making your eyes irritated or causing you to tear up, or rub the tissue around your eye a lot. Some times puffy skin is due to an allergy.

Second, if the sagging skin is mild to moderate, an Eyelid Thermage or two will tighten that skin and help reduce the sagging. As with hooding or sagging on the upper eyelid, this is most effective when the problem is mild to moderate. If you have a lot of sagging, you’ll need surgery to correct it. Read more about Eyelid Thermage treatments here:

Third, quite remarkable results can be seen for tightening eyelid skin with a fractionated CO2 laser. One to three treatments are needed over 3-6 months. Sometimes called the “Madonna Lift,” it offers an alternative for some patients to eyelid surgery.


Skin is Crinkly or Crepey

Many people are bothered by tiny fine lines on the upper eyelids that make the skin look like crepe paper or give it a crinkly look. If the problem is mild or moderate, then eyelid Fraxel is a good option to reduce the fine lines. Fraxel makes a special, tiny, FDA approved tip just for the eyelid area. Generally you’ll need 2-3 for the best results.

If there is mild sagging coupled with the crepiness, then the combination of 1-2 Eyelid Thermage treatments to tighten the skin a little with the Fraxel eyelid treatments to reduce the crepiness will give you an even better result. Or as an alternative, the fractionated CO2 laser which both tightens eyelid skin and helps with crepiness. In general, Fraxel or a combination of Thermage and Fraxel are more appropriate for women in their 30 or early 40s with the fractionated CO2 for women over 40.

Laser treatments on the eyelid are higher risk so make sure you see an experienced dermatologist or plastic surgeon for work around the eye area. Read more about Fractional lasers for the eye area here:

Dr Irwin


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