The Under Eye Dilemma

Posted by Azadeh Shirazi MD on

Behind each pair of tired eyes lies a story of sleepless nights, stress, genetics, and aging. It’s one of the most commonly seen and asked about skin concerns; dark circles and under eye bags. What causes them? How do I get rid of them? The questions I get asked are endless, so today we’re going to dive into the causes and treatments that can help in-office and at home.

I also have a dedicated youtube video on this topic, check it out below!

  1. What are the causes of under-eye bags?

The most common cause is aging because as the tissue and muscles weaken around our eyes, the fat pads begin to bulge and descend giving the under eyes a puffy appearance. Genetics also play a role as some people tend to accumulate more fat under the eyes. We see this happen gradually over many years. Puffiness from swelling and fluid retention is another common cause particularly from alcohol, dehydration, crying, allergies, and colds. Other causes include hormonal shifts and imbalances, thyroid, and kidney disease so it’s best to see your doctor if you are experiencing eye bags despite eating healthy and sleeping well. 

  1. Is it possible to get rid of under-eye bags? How long might this take?

If it doesn’t happen in a few days then it can’t go away in a few days meaning if you had salty foods or slept poorly you can wake up with under eye bags as a result of swelling and puffiness which in turn can resolve quickly using the right measures. In general it can take 24-72 hours depending on the cause and one’s metabolism. If the cause is structural such as eye bag changes seen with aging over years, then it may require a surgical or in-office procedure.

  1. Are under-eye bags the same as puffy eyes? 
Puffy eyes are often due to swelling of the tissue around the eyes or fluid retention leading to the appearance of under eye bags.  Whereas eye bags are often referred to as fat pads under the eyes that create a puffy or baggy appearance. 
  1. How Can I reduce my under eye-bags?

 First I tell my patients to drink 8-12 oz of water upon awakening in the morning to flush out any excess salt and to hydrate your body since it’s been without water overnight.  Applying chilled or frozen tools, eye masks, or devices helps temporarily constrict blood vessels and deflate puffiness fast.  These can be applied in combination with a lymphatic drainage massage.  Stay away from salt, sugar, and alcohol for at least a week to see a big difference in reducing the appearance of under eye bags. You can also use a caffeine based eye gel to soothe inflammation, help with circulation, and narrow leaky blood vessels to reduce swelling, fluid retention, and puffiness. Using a retinol based eye cream like Eyeglow PM can help boost collagen and firm the skin over time. If you suffer from allergies then taking a daily antihistamine like Claritin can also help under eye puffiness and eye bags.

  1. What types of in-office treatments are there to get rid of under eye bags?  

Blepharoplasty: is a surgical procedure where the bulging herniated fat pads are removed from under the eyes and sometimes transferred to areas of fat loss from aging.  

EyeGlow® filler: is a non-surgical option, a patented technique I developed using a white opaque filler blend to lift the under eyes, mask eye bags, and brighten the under eyes similar to how white concealer is used to highlight the under eyes. The EyeGlow® white filler also adds support and structure to certain facial ligaments that weaken and sag with age.  This helps reduce under eye bags and lasts for many years. 

Exilis: using radiofrequency and ultrasound helps tighten the skin and reduce eye bags. There’s no pain or downtime so it’s a great non-invasive option. 

Laser Resurfacing: with a CO2 laser can help tighten the skin and improve eye bags.

If you’re curious about some of these procedures and what they may look like, I have an in-office treatment video dedicated to EyeGlow® and Laser Resurfacing. Check those out below! 

  1. What Are The Best At-Home Treatments/Tricks to Reduce Under-Eye Bags?

A few options for at home remedies can be

  1. Chilled Cucumbers Soaked in Black Tea: one of my favorite at home spa remedies to reduce eye bags in the morning. Cucumbers have a high water content and act like a natural ice pack while the caffeine in black tea helps draw out the excess fluid. The tea’s caffeine boosts circulation, soothes the area, and tightens the blood vessels in the under eyes, therefore reducing puffiness and inflammation. 
  2. Cold Eye Roller: specifically ones that dispense skincare to glide in a pattern that boosts lymphatic drainage and helps reduce eye bags. I favor L’Oreal’s HA & caffeine serum as it comes with three cooling, stainless steel balls that bends and it’s affordable and accessible. Also, EyeGlowAM formulated with peptides, kelp and rich in antioxidants that reduce inflammation, hydrate, and plump the skin - dispensed from a cooling tip. Using gentle pressure, glide in an outward and upward direction with multiple passes to visibly see the puffiness improve.
  3. A temporary quick fix such as Peter Thomas Roth’s Instant FirmX eye gel that uses sodium silicate, an inorganic salt that leaves a thin film on the skin. When that film dries, it pulls the loose skin tight temporarily.  The effects last for several hours. They can be tricky to use with makeup and the effects only last for a few hours.
  4. Develop good sleep hygiene to get a good night’s sleep because it’s one of the best prescriptions to combat eye bags. Light at night, particularly blue light, is one of the reasons people don’t get enough sleep as it suppresses the secretion of melatonin, a hormone that influences circadian rhythms. In fact, switch your phone screens to red light 3 hours before bed as it has a calming effect. I also suggest sleeping on a couple of pillows if you are prone to eye bags to minimize pooling fluid to the eye area.
  5. EyeGlow PM:Formulated with Retinol to tighten the skin, caffeine to depuff the under eyes, brightens dark circles, soothes inflammation reducing under-eye puffiness. Apply 1 pump cold using your ring finger to tap along the under eyes from the inside outward at bedtime to wake up with reduced eye bags.

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Dr. Azadeh Shirazi, MD is a Board-Certified Dermatologist.

Specializing in medical, surgical, and cosmetic dermatology, Dr. Shirazi received her undergraduate and medical degrees from the University Of Kentucky College of Medicine. After doing a Research Fellowship at Harvard Medical School at the Wellman Center for Photomedicine, she completed her residency training in Dermatology and Cutaneous Surgery at the prestigious Mayo Clinic in addition to completing her training in dermatology and cosmetic surgery at the University of California San Diego.

She has received multiple research scholarships from iconic institutions including Harvard University and the University Of Texas Southwestern Medical Center and has several peer-reviewed publications to her name.