Banish the Bags Under Your Eyes

Noticing bags or dark circles under your eyes ? You're not alone.

Dermatologists and plastic surgeons get asked about dark circles and under-eye bags all the time. "I hear patients voice complaints several times a day," says dermatologist Valerie Goldburt, MD, PhD, of NYU Langone Medical Center.

Good news: There are fixes for under-eye flaws. The first step is figuring out just what the problem is.

Morning-After Puffy Eyes

Seasonal allergies, a cold, a sinus infection: These are some of the things that can lead to water building up under the eye.

"We have the thinnest skin around our eyes, so it's the area that's most influenced by the in-and-out flow of fluids," Goldburt says.

A dinner heavy with salty food or a night of crying while watching a tearjerker movie can also cause morning-after puffiness. The reason is osmosis. "Water always travels from areas in the body where there's low salt concentration to tissues where there's more salt, Goldburt explains. That principle holds true whether the salt comes from tears or from soy sauce.

Simple Fixes for Under-Eye Bags

Addressing the underlying cause will help treat these temporary eruptions of puffiness.

Here are steps to try:

• Treat hay fever, if that's the problem. There are non-sedating, over-the-counter allergy medications that may help. If you have or suspect hay fever, talk with your doctor about how to treat it (whether or not it's affecting your eyes' appearance).
• Try a neti pot. Irrigating the nasal cavity with a neti pot -- a device that looks like a small teapot -- can help relieve fluid buildup caused by allergies, sinus congestion, or a cold.
• Switch your sleep position. Your sleep position may be contributing to under-eye bags. Thanks to gravity, sleeping on your side or stomach can encourage fluids to collect under your eyes. If you're a side sleeper, you may notice a heavier bag on the side you sleep on. Goldburt advises her patients who wake up with puffy eyes to sleep on their back and add an extra pillow under their head.

Changing your sleep position takes some getting used to, says Goldburt, a self-described "former eye-bag sufferer" and stomach-sleeper herself. Still, she says, "The earlier you start changing your sleep position, the better, because after a few years under-eye bags can became permanent."

Other everyday habits, including rubbing your eyes frequently, going to bed with makeup on, and excessive drinking, can contribute to under-eye bags, too. "Sleeping in eye makeup can irritate your eyes, causing fluids to pool," Goldburt says. Heavy alcohol drinking causes dehydration . That weakens the delicate skin around the eyes, making it more likely to sink into a pouch.

Eye bags are very common, and are usually not related to your health. But if your bags appear suddenly and you're not suffering from allergies, a sinus infection, or a cold -- and they don't ease up when you try the lifestyle steps mentioned above -- it's a good idea to see your doctor. Some thyroid or kidney problems can cause under-eye fluid retention, notes New York dermatologist Craig Austin, MD.

Dark Circles

When dark shadows or bags linger, the cause typically is not something temporary, like a few too many cocktails. It might be something you've inherited. Pigmentary issues that cause under-eye discoloration are common among people of Asian or African descent. Age also contributes to dark circles. With age, the skin around the eye thins, exposing the tiny blood vessels that lie just below.

Still, you can do something about it.

If you pull the skin sideways and the darkness turns blotchy, that's evidence the problem is caused by excess pigment in the area, says Joseph Eviatar, MD, a New York ophthalmic plastic surgeon.

Most often, dark circles aren't about changes in the color of the skin at all. Instead, they're created by a loss of volume in the area around the eye. That exposes the orbital bone, creating a hollow trough that shows up as a dark circle. With the delicate eye area one of the first spots to reveal signs of aging, this can happen as early as the late 30s or 40s.

What can you do?

Makeup can help conceal dark circles. Hiding dark circles with concealer is simpler than you may think, says New York makeup artist Kimara Ahnert. Choose a concealer that matches your skin tone. If you have mild discoloration, pick a liquid formula. If your shadows are more prominent, go for more coverage with a cream or cake concealer. Lightly pat the concealer on from the inner corner of your eye to just past the outer corner.

Other, more expensive options, including treatment with IPL or intense pulse light, can help by destroying those pigment cells and smoothing the skin. A series of four IPL treatments, at about $200 each, is typically needed to see improvement. Skin lightening creams that contain hydroquinone or kojic acid may also diminish the darkness.

These fixes are less successful when the dark circles are caused by extremely thin skin. "That's really difficult to treat," Eviatar says. "Eye creams that contain caffeine may help a bit because they constrict the underlying blood vessels."

Prevention and Quick Fixes

Here are four things you can do -- without surgery -- to help keep your eyes looking youthful.

1. Don't smoke, and always apply a sunscreen around the eye area. Smoking and exposure to UV rays both weaken collagen and cause premature wrinkling and sagging.
2. Apply a moisturizer to the eye area nightly. "You don't need to spend a lot," Goldburt says. "Almost any drugstore moisturizer will provide the hydration you need."
3. Add a prescription retinoic acid -- the vitamin A cream that goes by the generic name tretinoin -- to your daily skin care regimen. "It's the single best thing you can use to prevent wrinkles and improve existing lines," Goldburt says.
4. To calm puffy eyes, place cold spoons, slices of cucumbers, chilled tea bags, or even a package of frozen peas under your eyes. The cool temperatures -- rather than any special properties of cucumbers or peas -- reduce swelling. And, yes, placing a hemorrhoid cream under your eyes might help get rid of puffs, too. "We have patients who swear by it," says Brent Moelleken, MD, a Beverly Hills plastic surgeon, "but we suggest a retinol eye cream instead."

Fillers for Hollow Eyes

Some people choose to get hyaluronic fillers, such as Juvederm or Restylane, injected under their eyes. "Fillers mimic a youthful look by correcting the contours of the eye socket," Eviatar says.

If you pursue this, you really want someone who knows what they're doing. Injecting dermal fillers under the eye is, Moelleken warns, a very "technique-dependent" procedure. The filler needs to be injected deep under the muscle rather than into the superficial layers of the skin. An inexpert job can lead to puffiness. So choose a skilled, board-certified dermatologist, plastic surgeon, or ophthalmic surgeon who is experienced in under-eye injections.

The procedure costs about $500 to $700. Results last about eight months. Ask your doctor about side effects, such as minor swelling and bruising that can last for a week or two. Your doctor may suggest injecting Botox, Dysport, or Xeomin (wrinkle-smoothers that erase crow's feet) at the same time. But it's up to you how much, or how little, you want to do.

Eyelid Surgery Gets a Makeover

Some people choose to go further to address sagging skin that creates pouches under their eyes.

Today, eyelid surgery, or blepharoplasty, is done through incisions made in the eyelid. Doctors may remove a little bit of fat, reposition the fat, or even add fat grafts, depending on what's needed. Lasers are used to firm up loose skin. These procedures cost between $2,500 to $5,000, and recovery from bruising and swelling takes 10 days to two weeks.