Puffy Eyelids & Dark Circles
What are Puffy Eyelids?
The lower eyelid has three fatty pockets, all about equal in size, that are involved in any puffiness you see. If you look up to the sky these fatty pockets become temporarily accentuated. After reclining for an extended period of time you may see them more prominently because fluid can accumulate in tissues of the lower eyelid.
What Causes Puffy Eyelids?
Puffy eyelids are most often caused by herniation (bulging) of orbital fat (the fat from within the eye socket) that pushes up against the lower eyelid. As we age, the muscle in the lower eyelid weakens, as does the septum (the "net" holding back the fat) and the fat starts to push out against the weaker lower eyelid.
In addition, the fat of the upper cheek atrophies and the muscles in that upper area weaken, which causes the cheek to sag. This leaves a concave area between the lower eyelid and the falling cheek, which looks like a line or hollow, above which is the lower eyelid. The convex curve of the lower eyelid, because of the bulging of the fat, becomes accentuated and that makes the eyes look puffy and tired. Finally, some people are born with excess lower eyelid fat - it's a trait that runs in families.
While puffy eyelids also can be caused by water retention, allergies, or sinus infections, these are temporary situations that go away when we address the cause. More rarely, we identify an underlying kidney or heart disorder that can cause the eyelids to be puffy. This is why it's important to be evaluated by a physician if what you believe is temporary eyelid puffiness doesn't resolve.
How To Prevent Puffy Eyelids
No good way exists to prevent puffy eyelids caused by aging and genetics. Losing weight doesn't seem to have any bearing on this fat, but a reduced-salt diet may prevent puffiness related to water retention. Some people find that sleeping with the head elevated on two pillows as opposed to lying flat may help. This will allow the fluid to drain instead of accumulating in the eyelids.
Topical And/Or Oral Treatments
Puffy eyelids caused by infections or allergies need medical treatments such as antibiotics or allergy medications. In the case of water retention, measures that constrict the blood vessels and reduce swelling may help; these include cold compresses and the cold cucumber "eye pads" we sometimes see in movies. I've known people who swear by hemorrhoid creams. While hemorrhoid creams are not a normal indicated topical agent for puffy eyelids, some of these creams may contain an agent called phenylepherine, which is known to constrict blood vessels. These creams may then reduce fluid in the area and in turn reduce the puffy appearance.
I do not recommend taking powerful diuretic medications; they can cause havoc, because they upset the electrolyte balance, i.e., the balance of sodium and potassium in the body, a potentially dangerous situation.
Procedures And Other Treatments
Excess puffiness around the eyes from fatty pockets requires a surgical procedure (blepharoplasty) to resolve. However, fillers such as hyaluronics (like Restylane and Juvederm) can often be used to improve the appearance of puffy lower eyelids, which is often the result of fat bulging from behind the eyes in combination with sagging or falling of the cheek fat, which leaves a depression or hollow between the cheek and the eyelid. (See Fillers, Part IV.) Sometimes, as mentioned above, this condition is made worse by allergies, sinusitis, or salty foods. Caution:Restylane / Juvederm correction in the eye area is technically complex and you will want to find an expert, experienced injector to treat this area.
What Are Dark Circles?
Dark circles are the common term we use for what appear to be unevenly darkened skin beneath the eyes.
What Causes Dark Circles?
What we commonly call "dark circles," or what look like dark circles, can come from bulging fat pockets in combination with a hollow below the eye, which together create shadows around the eyes. Excess skin pigmentation or thin skin with the blood vessels visible may also make the skin appear darker.
How To Prevent Dark Circles
Sun screens are a must in this area especially if the dark circles are caused by excess pigmentation, which worsens with sun exposure. If the circles are secondary to allergies or sinusitis these conditions need to be treated with antihistamines or antibiotics. If the circles are due to shadows then no real preventive measures exist.
Topical And/Or Oral Treatments
We don't have any good oral or topical treatments for dark circles linked with aging or shadows. For the most part, camouflaging makeup products are the only viable option.
Procedures And Other Treatments
Dark circles are a difficult problem to treat. However, if the dark circles appear to be caused by bulging fat pockets, then a nonsurgical option, such as a filler, may be an option. (See Part IV.) Surgery (blephroplasty) to remove the fatty pocket may also be an option.
Dark circles resulting from tiny blood vessels are also difficult to treat and no good option currently exists. I may offer surgery or a laser procedure if I believe that I can remove the vessels. If the dark circles are due to excess pigmentation, I have found that a chemical peel containing TCA best reduces lower eyelid pigmentation. (See Part IV, Chemical Peels, specifically TCA.)
Caution: Although a nonsurgical mesotherapy injection of a chemical into the fat pocket is being touted by some physicians, this method of treatment is very new and its safety has yet to be confirmed. Likewise, although a laser can be used effectively to treat dark pigmentation elsewhere, it is often hard to get the laser into a good position near the eye to treat this area effectively.
See also Wrinkling for further discussion of the eye area.
