Under-eye bags - how to get rid of them?

You slept eight hours. You feel fine. And at work the third person that day asks whether everything is really all right, because you look tired.

This is the sentence we hear most often in the office. Not "I have bags under my eyes", but "I am tired of explaining that there is nothing wrong with me".

Patients usually come to us at the same point: when extra hours of sleep and a full-coverage concealer have stopped being enough.

Three different problems, one everyday name

And this is where the most important distinction in this whole subject begins.

"Under-eye bags" is a collective name covering at least three different things. They look similar in the mirror. But they have different causes and — more importantly — different solutions. A treatment that helps one person will do absolutely nothing for another.

• Swelling — water and lymph retention — Variable. Worse in the morning, subsides during the day. Intensifies after a salty dinner, alcohol, a sleepless night, during allergy season · Lifestyle, diagnosis of a systemic cause, lymphatic drainage.
• Shadows and the tear trough — volume loss — Constant. A hollow beneath the eye socket, a dark ring that does not disappear after a good night's sleep. Also visible in photos from your youth · Volume restoration, skin biostimulation.
• Fat herniation — bulging of the orbital fat pad — A constant, distinct bulge of the lower eyelid. It does not change during the day and does not respond to sleep or diet · Surgical treatment — blepharoplasty.

Remember one thing: if the bulge does not change throughout the day, no cream, drainage or filler will remove it. That is a job for a surgeon.

Why here of all places

Because the skin around the eyes is built differently from the skin on the rest of the face.

It is much thinner. It does have sebaceous glands, and plenty of them, but there is almost no subcutaneous tissue beneath it — and it is precisely this that makes the vessels show through so strongly and the eyelid swell so easily. As a result it ages faster, wrinkles form on it more easily and water retention occurs in it more easily.

Then there is the lymph. As the tone of the orbicularis oculi muscle decreases, lymph outflow worsens — and the lower eyelid begins to swell.

Where the shadows come from

Some patients have had them forever. In conversation it turns out that their mother, grandmother or sister had the same. Dark circles under the eyes are sometimes simply genetically determined, and women with deep-set eyes are more prone to them — the shadows are often visible in them from an early age.

The rest comes with time. The skin becomes thinner, so the blood vessels beneath it show through more strongly. Fat tissue around the eyes is lost. The orbital bone recedes. The result: a hollow and a dark ring you cannot sleep off.

But darkening around the eyes also has causes that have nothing to do with beauty:

• allergies,
• taking certain medications,
• past illnesses,
• improper functioning of certain organs.

That is why the first step is a consultation, not a treatment. The doctor will assess whether it is a matter of physiology, lack of sleep, or a signal that something is going on in the body.

To be specific: chronic swelling of the eyelids can be the first visible sign of thyroid disease, anaemia, kidney disease or a contact allergy to a cosmetic. That is why at the consultation we ask about medications, chronic conditions and recent blood tests, and sometimes we ask you to have them done before any treatment. An aesthetic treatment carried out on such a background gives a short and misleading result — it masks the signal instead of removing the cause.

Before you think about a treatment

We approach health and beauty holistically. When a patient comes to us with bags and dark circles, we first look at her health and lifestyle — because it sometimes turns out that instead of treatments she simply needs more sleep, more rest and a change of eating habits.

That trio improves not only the skin but also how you feel.

Moderate physical activity, drinking plenty of water and a diet with a minimum of salt, simple sugars and processed food are the first step towards improving the condition of the whole body — not just the eye area.

And then there is daily care. Always remove your makeup, whatever the circumstances. Cleanse the eye area with ophthalmologically tested products — gentle but effective, ones that do not require rubbing and irritating the thin skin of the eyelids.

Treatments: what works for what

You live a healthy lifestyle, you get enough sleep, your cosmetics are well chosen — and the shadows and bags are still there? That is when aesthetic medicine comes in. The method is matched to the cause.

• Hollows, tear trough — Hyaluronic acid filling, elimination of under-eye shadows · Fills the space, reduces the hollow. The skin is brighter and more taut, and long-lasting hydration is added. The effect is visible immediately, as you leave the office.
• Dry, dehydrated eyelid skin — Needle mesotherapy · Nourishes and regenerates the skin without fillers. Brightens dark circles gradually — the effect is not immediate.
• Delicate eye area, a need for hydration — Nanoneedle mesotherapy · Introduces active substances very superficially, designed for the thinnest skin.
• Laxity of the eyelid skin — Fractional microneedle radiofrequency, biorevitalizing PDO or PLLA threads · Stimulation of the skin to remodel and produce collagen.
• Swelling from lymph retention — Endermolift LPG facial drainage massage · Unblocks the puffy lower eyelid. Stimulates the production of collagen, elastin and hyaluronic acid.
• Fat herniation, excess eyelid skin — Blepharoplasty · Surgical correction of the upper and lower eyelids.

Important: skin-stimulating treatments are performed in a series. A single visit will not give a lasting effect — the eye area requires regular stimulation.

We talk about risk before the treatment, not after it. After hyaluronic acid is injected under the eyes, about one person in five gets temporary swelling or a bruise — this is normal and passes on its own. Less often there is a bluish tint to the skin when the product is placed too superficially, or persistent swelling of the cheek; both can be reversed by dissolving the product with an enzyme called hyaluronidase. Very rarely, but genuinely, a vessel can become blocked — which is why a treatment in this area is performed by a doctor only, and any sudden pain, paling of the skin or worsening of vision after the treatment is a signal to contact the clinic immediately.

When to see a doctor rather than a beautician

Book a consultation if:

• the swelling appeared suddenly and does not subside,
• it is accompanied by itching, watery eyes or a runny nose — it may be an allergy,
• the eyelid bulge is constant and does not respond to sleep,
• the change affects only one eye,
• you suspect a connection with the medications you are taking.

What next — depending on what you have

Dark circles and puffiness can be masked with makeup. But a comprehensive approach gives longer-lasting results: a lifestyle change plus a well-chosen treatment. Over time, patients give up full-coverage concealers altogether.

To hit the problem, though, you first have to name it:

• Does it swell in the morning and subside in the evening? Start with sleep, salt and alcohol. If that does not help — check for allergies and get your test results. Only then drainage.
• Do you have a constant hollow and a dark ring? Most often that is volume loss, but a dark ring can also be pigmented or vascular — and then a filler alone will not help. The doctor identifies the mechanism at the consultation, and that decides whether we are talking about fillers, about mesotherapy, or about treating pigmentation.
• Is the bulge unchanged throughout the day? That is most likely a fat herniation. Book a surgical consultation — what helps here is blepharoplasty, that is, eyelid surgery. The procedure is performed under local anesthesia, and the stitches come out after a few days — for a full return to your usual appearance, however, you need to allow more time.

The realistic timetable after lower eyelid surgery looks like this: the stitches come out after a few days, but the swelling lasts two to three weeks on average, and bruises are the rule, not the exception. People usually go back to desk work after a week, and to photographs and meetings where you care about how you look — after three or four weeks. It is worth taking this into account when planning a date.

The worst scenario is years of attempts from the wrong shelf. It takes a doctor one visit to tell these three situations apart.

Shadows resulting from volume loss are corrected with the elimination of under-eye shadows, and fat herniations are resolved by eyelid surgery.

This article was prepared by the team of the Dr Kuschill MEDESTETIS clinics.

Medical supervision: Joanna Kuschill-Dziurda, MD, PhD — specialist in allergology, specialist in internal medicine, aesthetic medicine physician.