How to make your eyes look less tired
A common frustration many people have is looking tired when they’re not. The most frequent complaint is “bags” under the eyes. While drooping brows generally impart an “angry” look, typically bags or dark circles under the eyes generate the appearance of tiredness. We get many patients who are frustrated that friends and coworkers keep asking them if they’re tired, even when they’re not. Many will try over the counter cosmetics to try to conceal or even “remove” the bags, but they quickly discover these over the counter treatments just aren’t as effective as something a cosmetic surgeon can deliver. Our goal is to eliminate or reduce the abnormality so the patient looks refreshed again.
Get Rid of Those Under Eye Bags
When a patient comes in complaining of bags under their eyes, the first thing I do is get a good history and make sure there’s not a medical reason for this. For example, bags that get better and worse throughout the day, or during certain seasons, may be simply due to allergies. Or sometimes, patients actually were exhausted when they develop these bags. If after questioning I determine the concern is fairly constant all day, then the next step is to examine the eyelids carefully. While there are several possible reasons for bags or dark circles under the eyes, the two most common causes are fat or hyperpigmentation.
When fat is the source of the bags, there is loss of the normal smooth convex contour from lower lid margin to cheek. We see a “hill” from the fat, progressing to a “valley”—or volume loss, then back to the cheek (hill). The bags are not caused by fat growth. Instead, the septum (a sling like structure that supports the infraorbital fat) weakens and lets fat herniate through. This protrusion of fat is what causes the lower lid to bulge. In this scenario, there are two main strategies to address this. They are fillers or surgery. Today, the most popular choice is dermal fillers. The majority of patients desire minimally invasive treatments, with less downtime, and fillers can achieve this. Fillers improve the lower bag look, not by removing the offending fat, but by camouflaging the contour irregularity. The filler is placed in the “valley” so that a smoother convex profile is achieved. This is a very effective treatment, but there are some limitations. One, someone with significant fat pseudoherniation won’t get a dramatic improvement. Another obvious limitation is fillers are not permanent. However, fillers placed below the eyes and in the tear trough deformities tend to last a lot longer than if they were placed somewhere else. In my experience, they can last 12 -18 months. The same filler placed around the mouth may last only half that time. While any filler can be used, almost every cosmetic doctor I know will use a hyaluronic acid filler like Juvederm or Restylane. I like Restylane over Juvederm because Restylane is less hydrophilic, meaning it attracts less water—leading to less swelling. Just recently, I’ve been using Juvederm Volbella, a new product from Allergan that uses the Vycross technology. Volbella is less hydrophilic than Juvederm and has achieved good results too.
The definitive way to treat the fat, though, is surgery. While the downside is need to take some time off work or school, the results are more dramatic and last decades. Another important consideration is surgery carries some rare risks. Bleeding, bruising, swelling, and infection are all uncommon, with injury to eye and blindness exceedingly rare fortunately. My favorite technique is to remove the fat via a transconjunctival approach (behind the eyelid) so that no external scars are present. For many of these patients, periocular CO2 laser resurfacing can enhance the results.
The second most common cause for dark circles under the eyes is hyperpigmentation. Here, the skin is dark and creates the illusion of a bag under the eye. If one has hyperpigmentation alone, then fillers or surgery won’t solve the problem. One needs to apply some lightening cream such as hydroquinone to decrease the darkness. There is a chance the patient will have to do this regularly throughout his/her life since rarely is the hyperpigmentation “cured” with one session. Another uncommon cause for dark circles is using Latisse. I’ve seen a handful of women develop this unfortunate side effect from using Latisse. This is very disappointing for these patients because they got the lush eyelashes they wanted, but now have an unattractive “zombie” look. Fortunately, this side effect gradually goes away after stopping Latisse.
Having bags or dark circles under the eyes can be very annoying to many people. Having people constantly ask if they’re alright or if they’re tired gets old. This nuisance can also impede one’s job if they have to frequently stop and reassure their clients they are fine. Fortunately, we have effective minimally invasive as well as surgical treatments to remove the bags so that you can look refreshed and positive like the way you feel inside.
For more information about San Antonio cosmetic surgery contact Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery. We are a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please call our Concierge Patient Coordinator at (210) 876-6868 today.
