Bags Under The Eyes: How To Treat Your Concern

Content Reviewed by AEDIT Medical Advisory Board

Overview

Several factors influence the appearance of the skin, and under-eye bags and dark circles are no exception. This is also part of the natural aging process, and you may begin to notice a darkening of the under eye area or see bags appearing where they weren’t before as you age. During youth, the body naturally produces a significant amount of collagen and elastin, both of which are responsible for the skin’s firm, smooth appearance. This is important because growing skin requires a higher level of elasticity and strength to stretch and develop. As we age, though, the production rate of collagen and elastin decreases, and the skin begins to sag and wrinkle as the supply of those ingredients becomes less and less naturally accessible. Once the drooping and sagging begins, you will notice things like dark circles, under eye bags, fine lines, and wrinkles appearing on your face with more frequency and intensity.

Under eye bags indicate a breakdown of the tissues, and sometimes even the muscle, of the area surrounding the eyes. Where collagen and elastin once helped keep your fat cells strong and lifted, they are now sagging into the lower eyelid area causing a puffy, baglike look around your eyes. It can also cause the area to darken and take on a bruise-like appearance, or in the case of thin, sensitive or delicate skin, blood vessels become more visible as you age leading to dark circles. Usually these aesthetic changes are normal and harmless, but sometimes they can be indicators of something more serious, such as allergies, infections, or diseases, although those situations tend to be somewhat rare.

There are several treatment options available, as well as prevention methods worth trying before surgery which will be discussed throughout this article. While relatively harmless, there are times when the drooping becomes severe enough to inhibit vision and warrant surgical remedies to reverse those issues. Other times, the visibility of dark circles and bags becomes discouraging and a person will seek surgical help to correct their appearance. Either way, it is important to understand the information available to make the best decision for your needs.

Terminology/Definitions

Below are a few terms, and their correlating definitions, that you will encounter as you read this article:

Bilateral: occurring on both sides Conjunctiva: a thin, clear membrane covering the front of the eye and lining the inside of the eyelid Dark Circles: a purplish or bluish bruising appearance, or shadow-like appearance, under the lower eyelid Eye Bags: a puffing or bulging of the skin, particularly in the under-eye region Infraorbital Regions: areas directly below the eye socket Pigmentation: coloring of the skin

Signs & Symptoms

Signs and symptoms of eye bags include a noticeable build-up of fat, skin, or tissue underneath the eyes. It could refer to temporary swelling due to a sleepless night or to deeper issues, such as a need to address existing allergies.

Signs and symptoms of dark circles include a shadow-like appearance or the look of bruising under the eyes. This is usually harmless and a result of the health of the blood vessels in the lower eye area becoming more visible with age.

Reasons and Causes of Eye Bags/Dark Under Eye Circles

There are many reasons eye bags and dark under eye circles might occur. Often, these present themselves as a natural result of the aging process, however, other factors contribute to the extremity of their appearance. For example, your sleep patterns, lifestyle, diet, and overall health each play a role in the development of dark circles and under eye bags. Most people have experienced waking up with noticeable “tiredness” manifested in the eye area after a restless night of little or no sleep. The under-eye bags and dark circles that you see are the tell-tale signs. Similarly, diet affects this area as well. A diet high in sugar, salt, and processed foods leads to fluid retention and a worsening of these problems. Your lifestyle – including smoking patterns and alcohol consumption – all factor into the way your body ages, and in turn, the way that plays out in areas like your face.

Other times, dark circles and under eye bags can be caused by other external factors. You could have seasonal or food-related allergies that trigger swelling or discoloration. They could also be a result of a deep emotional response, such as with the passing of a loved one, or a stressful season of life. Sometimes, and less frequently, under eye bags and dark circles could point to a more serious medical condition. Your practitioner will be able to advise you if they believe this to be the case once you have been seen for your bags and dark circles. Be sure to be specific and open about factors that may trigger this response from your body as this will allow them to better and more effectively guide you in suggesting the best remedies for your needs.

Pathophysiology

According to an article posted in the US National Library of Medicine dark circles are “bilateral, round, homogeneous pigment macules on the infraorbital regions” that are caused by several differentiating factors.

This simply means that dark circles are areas of discoloration just below the eyes, usually presenting on both sides and similar in coloring. The area is not necessarily raised but is discolored. This can be a result of melanin, responsible for pigmenting the skin, sun exposure, hyperpigmentation, an allergic reaction, swelling, the position of blood vessels in the eye area or from loose, sagging skin.

Under-eye bags refer to the puffy skin under the lower eyelid area. This is usually a result of the natural aging process or the anatomical structure of the face itself. Genetics plays a role, as does your typical diet and lifestyle, however, this is often only an aesthetic concern and is very rarely serious. More serious conditions might include periorbital edema, where fluid causes inflammation or blurred vision and eyeball bulging. Speak with your doctor if you believe your eye bags need more than cosmetic correction.

How to Get Rid of Eye Bags/Dark Under Eye Circles: Treatments, Remedies, and Other Options

There are a few different approaches to alleviating the problem of dark circles and under eye bags. There are both surgical and non-surgical needs you may want to consider, however, remember that once the dark circles and bags have made their appearance, they may not ever be fully removable.

Eye Bag Removal Surgery: The surgical option for removing under eye bags is referred to as blepharoplasty. Several different blepharoplasty surgeries address various concerns of the eye area, however, this particular problem requires a lower eyelid blepharoplasty. This procedure type can be performed via the transconjunctival approach or the transcutaneous approach.

The transconjunctival approach noticeably reduces the bags and puffiness of the under eye area. During this approach, your surgeon will place an incision just inside the lower eyelid and uncover fat pockets with a double skin hook or traction suture technique. After this resectioning or removing of fat deposits in the lower eyelid, your surgeon will return the leftover fat and conjunctiva to their original positions. The area heals by itself in approximately 1-2 weeks without needing sutures as the orbital fat will have been replaced to cover the incised area.

This approach is helpful for younger people who have minimal fat and muscle bulge and whose skin is still relatively smooth. It does not work as well for those who have a great deal of skin laxity or sagging. A lower eyelid blepharoplasty utilizing the transconjunctival approach usually costs between $2,000-$4,000.

The transcutaneous approach is another viable option for addressing under eye bags and dark circles under the lower eyelid. This also requires an incision, but this incision will be outside the eyelid, just below the lower lash line, as opposed to inside the eyelid as in the approach above. The position of this incision helps allow the surgeon to address the excess skin and fat that contribute to the worsening of under eye bags and dark circles. The transcutaneous approach also enables your surgeon to tighten the lower eyelid muscle. Fat removal in this area will be minimal and not forced to protect the area from the damage. This means that only the excess fat – the fat that runs into the incision while it is open – will be removed. The skin-muscle flap is then replaced and the vertical lid suspension is closed with a running suture. Surgical glue and surgical tape may also be used to provide additional support as the area heals.

A lower eyelid blepharoplasty that uses a transcutaneous approach is a good option for those who are older and have a significant amount of fat or excess skin. It is also beneficial for those with prominent orbicularis muscle swag (issues with the muscles responsible for opening and closing the eyelids), which takes into account the look of the eyelid itself. This procedure is not recommended as an option for people with chronic dry eyes, those whose eyes bulge, or those who have a history of thyroid disease. The cost of this approach is between $2,000-$4,000.

Laser Skin Resurfacing: This technique refers to a cosmetic procedure that addresses minor skin concerns through the use of laser technology. This procedure has proven to be a powerful resurfacing treatment in the last 15 years. It works by retexturing and removing the outer layers of skin to stimulate the production of new skin cells. These new skin cells provide your facial area with a smoother, tightened, more youthful appearance. Laser skin resurfacing uses techniques that can be either ablative or non-ablative, as well as fractional or non-fractional.

Ablative laser resurfacing treatments are more invasive as their purpose is to aggressively remove the outer layer of skin as opposed to simply warming it as with non-ablative methods, although both provide noticeable resurfacing results. Fractional lasers are used to target a specific area at a time while non-fractional lasers reach larger parts of the skin at once. These can be used in various combinations, as determined by your skin needs, addressing anything from mild blemishes and wrinkles to the more severe concerns of scarring, hyperpigmentation, and deep wrinkles. Your cost and recovery time will be determined by the combination you and your provider choose for your needs.

Regardless of the type of laser resurfacing used, your dark circles and under-eye bags benefit from this treatment because of the way this technology encourages new collagen production. This is done through the way heat energy causes a healing effect in the under layers of skin, thereby targeting your under-eye concerns. By healing at a cellular level, even dark circles are targeted and made less obvious, and bags are made less obvious. An added benefit is that the new collagen helps to regenerate skin cells to create a smoother, more youthful appearance overall.

Dermal Fillers and Injectables: These options, while helpful and immediately noticeable, are temporary. They fill the soft tissues directly underneath the skin to fill out problem areas and generate the look of a smoother, more youthful appearance. Dermal fillers and injectables are particularly helpful for those who suffer from dark circles under their eyes because they are extremely efficient at pumping out the area. This is a great way for those with concave, or hollowed, under eyes to see improvement because this facial structure causes both shadowing and blood vessels to be more obvious. By plumping the area, these conditions are temporarily masked until the fillers are eventually absorbed by the body.

The FDA has approved a variety of dermal fillers and injectables in various price ranges that all provide different results. Review the list below to see which options appeal to your needs:

Collagen is naturally found in the body as one of the skin’s most important healers. As we age, we begin to produce less collagen which inevitably means more wrinkles and less tautness of the skin. Collagen fillers can be either human or bovine derivatives as the fibers are very similar. Both effectively plump up the skin as the collagen fibers are directly injected into, and absorbed by, the deepest layer of the skin.

Hyaluronic Acid is also naturally found in the body and is largely responsible for keeping your skin hydrated, and in turn, plumped. These fillers are soft, gel-like injections that are often infused with lidocaine, a numbing agent that helps alleviate discomfort associated with your injection.

Calcium Hydroxylapatite is a gel-like filler that, once absorbed, stimulates soft tissue growth and generates the production of collagen. Although calcium hyroxylapatite, commonly referred to by a brand name like Radiesse™, is made from minerals found naturally in human bones, this particular filler is biosynthetically manufactured. This simply means that it is created to mimic the original substance without using animal or human products.

Poly-L-Lactic Acid (PLLA) is a dermal filler named for the synthetic substance it uses. Often referred to by its trade name Sculptra® Aesthetic rather than the generic PLLA, this dermal filler was created as a biodegradable suture material that was later found to enhance collagen production in the area of its dissolution.

Polymethylmethacrylate Beads, Collagen and Lidocaine is a type of permanent dermal filler that is used in correcting nasolabial folds, which most people recognize as being deep smile lines, or sometimes in improving facial acne scarring on adult skin. The formula itself is called Bellafill™ and is made by combining microsphere-enhanced bovine collagen and lidocaine, a local numbing agent. Microspheres measuring approximately 30-50 microns are made from polymethylmethacrylate (PMMA), an FDA and USDA-approved synthetic material, and are added to the formula to create the implants. Bellafill™ can cause an allergic reaction in some people, and therefore, you will need to pass a skin test before treatment.

Sodium Hyaluronate is similar to hyaluronic acid, but has smaller molecules, which allows for greater solubility. Sodium hyaluronate-based gels include Restylane® Refyne and Restylane® Defyne.

Natural Alternatives, At-Home Remedies, and Non-Surgical Treatments

Although surgery, dermal fillers, and injectables all provide a more semi-permanent or permanent solution to the problem of dark circles and under eye bags, there are several natural alternatives or at-home remedies you may want to try.

Eye makeup is one of the fastest and easiest “quick-fixes” available for correcting dark circles, and when used correctly and naturally, it may also reduce the appearance of under eye bags. The Journal of Cutaneous and Aesthetic Surgery released a review that suggested the use of a concealer infused with optical diffusers such as mica or silica to camouflage and lessen the appearance of dark circles. It is also helpful to keep the area moisturized as dry skin will exacerbate the issues you are trying to fix. Sleep with deeply moisturizing eye cream and try soothing eye gels or moisturizing, nutrient-packed eye masks as well. These are a good way to reduce stress and improve the look of the eye area.

Retinoids are also helpful in reducing the intensity of dark circles and bags by encouraging collagen production and decreasing melanin in the under-eye area. After assessing your needs, your provider will be able to prescribe a retinoid or recommend an over-the-counter retinol option that you can apply at home.

Hydroquinone may also be an option, although, according to The Journal of Cutaneous and Aesthetic Surgery, this critical pigmentation player is unavailable in some countries, such as Europe and Asia, due to concerns about carcinogenesis and melanocyte toxicity. Speak with your provider for further information if hydroquinone is an option you wish to consider.

Topical caffeine is a good option for treating dark circles as well. The Journal of Cutaneous and Aesthetic Surgery explains that caffeine helps to treat dark circles directly related to conditions arising from leaky blood vessels. Some creams include this ingredient, however, you may want to try applying tea bags to the area as well. To do this, brew tea bags in hot water and apply the bags to each eye once they have cooled down but are still moist.

Increased water intake can do wonders for your skin and overall health. Contrary to popular belief, water does not add to fluid retention and swelling but aids your lymphatic system in draining properly, reducing swelling in the body and potentially lessening the appearance of under eye bags and dark circles. Along the same lines, you will want to avoid sodas and sugary drinks such as sweet tea, lemonade, and coffee drinks filled with taste enhancers (creams, sugars, syrups, etc.). These products cause dehydration and only worsen your facial concerns. A single morning cup of coffee or green tea may actually be helpful overall, but caffeine should be consumed in moderation and should always be followed by an ample amount of water to prevent dehydration.

Diet is another important factor in naturally reducing the look of under eye bags and dark circles. Eating a healthy, balanced diet allows your system to function properly. You should consider a diet that is full of nutrients, high in fruits, vegetables, and lean proteins, and low in processed, refined, and sugary foods. Consciously reducing your salt intake will help reduce swelling, as well. Foods high in vitamin C, on the other hand, will improve the appearance of your skin as it aids in natural collagen production.

Lifestyle choices also play a role in your overall facial appearance. Too many late nights, or nights of little sleep, will heighten the appearance of under eye bags and dark circles, as will consuming too much alcohol and smoking cigarettes. These inhibit proper blood flow and circulation and decrease hydration, all of which lead to under eye bags and dark circles, among other skin and health-related concerns. They can also interfere with your ability to get a good night’s sleep.

Cold compresses applied to the eye area may help temporarily reduce the appearance of dark circles and under eye bags. This can be a quick fix after a late night, for example, as they wake up your skin by increasing blood flow and reduce under-eye puffiness and dark shadows from a lack of sleep. Some people recommend cucumber slices as a useful home remedy as well.

Allergies may also be contributing to your eye issues. If your dark circles and under eye bags are stemming from allergies, or are accompanied by redness, itching, swelling or watery eyes, see your provider for an allergy medication.