09 March 2020
Tired of eye bags making you look older and more lethargic than you actually are? Today’s review is all about eye bags- the causes, treatments and demystifying some of the common myths about eye bags! I’ll also be discussing in depth one of the mainstays of non-surgical eye bag removal: under eye/tear trough fillers.
If you’ve ever wondered why eye bags can occur in younger people or how under eye fillers and whether haemorrhoid cream for eye bags work (true story, ask Kim Kardashian), this review is for you. Let’s start with the basics.
Eye bags look like pouches or bulges underneath the eyes. They are a structural problem arising from a combination of skin laxity, fat herniation and sagging of the cheeks. These factors occur because of aging and genetics. This explains why eye bags can appear in your 20s and 30s for some people.
Eye bags arise from structural causes that occur with aging which leads to:
1) Pseudoherniation of orbital fat and skin laxity
2) Cheek atrophy and descent
They sound like big and unpronounceable terms so allow me to break down each of them down for you.
The skin and muscles in our lower eyelids keeps the fat tissues in the under eye area in place. The fat tissues in the under eye (also called the tear trough region) exist to protect the eyeball.
With aging, the skin and muscles that support tissues of the eyeball become thinner. As a result of this, the support of the eyeball is gradually lost. This causes the fat around the eyes bulges outwards, causing prominent eye bags to form in the tear trough region.
Aging of the cheeks also contributes to the formation of eye bags. Our lower eyelids transition to the cheek in a smooth, convex continuum. As the cheeks become flatter and sag downwards, the cheeks cause an abrupt transition between the lower eyelid eye bag and the cheek and worsen the appearance of the eye bag.
Another condition that is often confused with eye bags is lower eyelid swelling or puffiness.
All of us have had eye puffiness o at some point in our lives. Our under eyes look more puffy after crying, lack of sleep or during an infection. Eye puffiness can also occur in medical conditions such as allergies. Puffy eyes from swelling and fluid accumulation is usually temporary.
Under eye puffiness is commonly confused with eyebags because both of these conditions may look similar and can co-exist together. However, it is important to distinguish eye bags from eye puffiness because eye bags arise from structural problems in the tear trough area and cheeks. Unless treated, eye bags can persist.
Eye bags are a structural problem arising from skin laxity, fat pseudoherniation and sagging of the cheeks. There isn’t much that you can do for eye bags except to lift the lower eyelid and cheeks; and to remove the orbital fat that is popping outwards. Let’s look at each of these factors.
The most common non-surgical treatment to lift up the eyelids and cheeks is with dermal fillers to the under eye/ tear trough region.
How do dermal fillers treat eye bags?
There are two main causes to eyebags- the bulge of the soft tissues of the eye and the hollowing and descent of the cheek.
When treating eye bags, both the lower eyelids and cheek have to be taken into consideration because the lower eyelids transition to the cheek in a smooth, convex continuum.
Dermal fillers address both problems of eye bags by a two-pronged approach: –
1. Tear trough correction-by placing the filler under the “fold” between the lower eyelid and cheek. The under eye filler gently lifts the tear trough up to the lower eyelid and smoothens out the contours in tear trough area where the eye bag is located
2. Cheek correction– The lower eyelids transition to the cheek in a smooth, convex continuum. Cheek fillers restore the deflated look and volume loss with age. When placed strategically in selected parts of the cheek, cheek fillers create a lifting effect to correct the abrupt transition of eye bags and the sunken and hollow cheeks. The additional benefit is that with the lifting effect and restoration of cheek volume, your face will look more youthful. To learn more about cheek fillers, please read my review on Cheek Fillers: All You Need to Know About Non-Surgical Cheek Augmentation.
How are under eye/ tear trough fillers for eye bag removal performed?
Let’s see how tear trough fillers for eye bags are performed in my clinic in Singapore.
Step 1: Face is cleaned and numbed.
Step 2: Markings are drawn on the face. I usually delineate the safety boundaries for the under eye area.
Step 3: Injection of eye bag filler into the under eye/ tear trough area.
And VOILA! Results of eye bags before and after under eye/tear trough filler.
What are the benefits of under eye/ tear trough fillers besides eye bags?
Besides supporting and lifting the orbital skin and tissues to remove the appearance of eye bags, under eye/ tear trough fillers are also used to treat dark eye circles. One of the causes of dark eye circles is caused by a hollowing effect due to skin and laxity and sagging and under eye/ tear trough fillers treat that too.
For an in depth review on dark eye circles, please read my post Dark Eye Circles: Laying I’m Tired to Rest.
Am I suitable for under eye/ tear trough fillers?
Under eye/ tear trough fillers are suitable for most patients whose eye bags with mild to moderate severity. Very severe eye bags will benefit better from surgery to remove the orbital fat pseudoherniation.
How soon can I see the results of under eye/ tear trough fillers?
The results are immediate.
Is there downtime for under eye/tear trough fillers?
There might be some swelling and bruising in the under eye area due to the capillaries in the tear trough area. This is temporary and will recover in 3-5 days.
What are the dangers and risks of under eye/tear trough fillers?
Under eye/ tear trough fillers are generally safe. Side effects are uncommon and they are:
3. Tyndall’s effect- blue discolouration of the under eye area when the under eye / tear trough filler is injected too superficially
4. Skin necrosis
6. Asymmetry due to under or over correction
7. Nodules due to superficial placement of the dermal filler
These side effects are not common and can be reversed with an antidote called hyaluronidase that can dissolve hyaluronic acid dermal fillers. Another tip would be to choose your doctor wisely- an experienced doctor would give you the best outcome.
I would also advise against overcorrection in the under eye/ tear trough region. Dermal fillers containing hyaluronic acid have the property of attracting water. Hence, it is best to undercorrect the under eye/ tear trough region to prevent bulges or puffiness. Any top ups can be done during the follow up.
If you would like to learn more about dermal fillers in general; please read What You Should Know Before Getting Fillers. I answered FAQs to dermal fillers – including the limitations of dermal fillers- in Female magazine and you might find this read useful
Aftercare for under eye/tear trough fillers?
The aftercare for under eye/ tear trough fillers is pretty simple. Avoid facials, strenuous exercises, forceful actions or massages to the face so that the under eye/tear trough filler will not migrate.
Also, please avoid alcohol and medications or supplements that may increase your risk of bruising such as vitamin E, NSAIDS, ginko biloba and fish oil.
Are under eye/tear trough fillers safe?
Under eye/ tear trough fillers are generally safe when performed by an experienced doctor. It is also best that you discuss with your doctor if you are taking any medications or supplements so that he/she can advise you which ones to avoid to minimise any bruising and recovery time.
Under eye/ tear trough fillers are reversible when hyaluronic acid fillers are used. The antidote, hyaluronidase can the dermal filler should any side effects or complications occur.
How long can under eye/tear trough fillers last?
Hyaluronic acid based fillers can last for 9-12 months. Under eye/ tear trough fillers are not permanent.
Are under eye/tear trough fillers painful?
There is some discomfort with under eye/ tear trough fillers. A lot of the discomfort is reduced with numbing the skin prior to injection of the dermal fillers.
I also prefer to use dermal fillers that contain lidocaine, a numbing agent, so that any pain during the eye bag treatment is significantly reduced.
Review of under eye/ tear trough fillers
Faz had under eye/ tear trough fillers injected by me to treat her dark eye circles. The treatment is very similar to having under eye/ tear trough fillers for eye bag removal. You can read her experience in her review, I Lived With Dark Eye Circles All My Life, Until I Got This Aesthetic Treatment.
One way to remove orbital fat causing eye bags is with surgery i.e. blepharoplasty. There are two main approaches to this surgery- transcutaneous (incision on the external lower eyelid skin) and transconjunctival (incision).
In Singapore, surgical eye bag removal is performed only by plastic surgeons. Surgery is effective for removing the herniated orbital fat causing eye bags. However, surgery is not without its risk of complications such as bleeding, swelling, infection, scarring, inversion and eversion of the lower eyelids.
A newer, minimally invasive treatment to remove orbital fat without surgery is the use of radiofrequency microcannula. Radiofrequency breaks down the orbital fat pads in the lower eyelid to eliminate eye bags. With a novel technology called Secret RF and AGNES RF, this radiofrequency is delivered directly and precisely into the orbital fat pad without causing injury to the surrounding skin and eyeball.
You can read more about non-surgical eye bag removal using this microcannula radiofrequency/ Secret RF in this post Non-Surgical Eye Bag Removal.
If you’re wondering which eye creams are the best to remove eye bags- unfortunately, eye creams are unable to correct the orbital fat herniation and skin sagging that cause eye bags. If you’ve read my blogpost Do Eye Creams Work? , you probably saw my answer coming.
You might have heard of an eye cream that is used by makeup artists as a quick fix for eye bags- haemorrhoid cream. Sounds weird, but Preparation H, a type of haemorrhoid cream, has some basis for reducing eye swelling. Haemorrhoid cream or Preparation H contains an ingredient called Phenylephrine. Phenylephrine is a topical decongestant that shrinks the tiny blood vessels under the eyes and this reduces swelling in the under eye area. So strictly speaking, haemorrhoid cream can help to reduce under eye swelling or puffiness temporarily but not eye bags.
A word of caution for those wanting to try out haemorrhoid cream- its use for reducing puffy eyes is off-label and can cause skin irritation. Preparation H also contains hydrocortisone, a type of steroid. Prolonged use of steroids on the skin can thin the skin and cause increased skin fragility and enlarged blood vessels.
We all love new bags, but not when they’re under our eyes. As we age, the skin around our eyes becomes thinner and the orbital fat tissues lying deeper to the skin start to bulge outwards. The cheeks also undergo sagging and this causes a separation of the junction of the lower eyelids and cheeks. These three factors are the main structural causes of eye bags.
The two main non-surgical treatments for non-surgical eye bags are under eye/ tear trough fillers and cheek fillers. The additional benefit of having these cheek and under eye fillers is that they also correct dark eye circles and sagging and hollow cheeks.
So there you go- a review on eye bags and the non-surgical treatment options. Thank you for taking the time to read this; this is a lengthy and technical post and I hope you found this useful! Please feel free to leave a comment if you have any questions 🙂