It’s no secret that the eyes are the window to the soul, but they’re also a huge factor in our appearance. Dark circles, hollow under-eyes and eye bags are all struggles we can encounter at any age, and they can make us look tired and a lot older than we’d like. Thankfully, there are several options to rejuvenate the area and turn back the clock.
We asked Woodbury, NY oculoplastic surgeon David Schlessinger, MD to walk us through his favorite treatments and procedures for the under-eye.
Dark Circles, Be Gone
There are a couple reasons why you might be struggling with dark circles, and lack of sleep is just one of them. If you suffer from chronically dark under-eyes, it could be the result of thinned skin, hyperpigmentation or hollowing in that area. As you might have guessed, that means there are a few options to resolve it.
“If there is hyperpigmentation, we can use laser or IPL (Intense Pulsed Light Therapy) in addition to brightening serum,” Dr. Schlessinger says. “We can also use PRP injections to thicken the skin and rejuvenate the area.”
If hollowing is part of the issue, it can be easily resolved without surgery a lot of the time.
“Hollowing of the under-eye area is often addressed with dermal fillers,” Dr. Schlessinger explains. “I almost always use a cannula to fill the area.”
If you’ve ever gotten an IV, you might be familiar with a cannula. Basically, a cannula is a thin tube that is often used to administer medication into a vein or drain fluid from a body cavity. A small needle is used to create an entry point, and then a cannula enters the site and, in this case, injects filler.
It’s preferable in the under-eye area specifically because the smooth, rounded cannula glides gently through the tissues creating much less bruising and swelling.
Filling Your Hollows
Separate from dark circles is the more advanced hollowing. Having hollow under-eyes can make you look permanently tired, as the lack of volume in the tear trough can make your eyes look sunken.
“This hollowing gives patients a tired appearance,” Dr. Schlessinger says. “And it is usually best treated with dermal fillers or fat transposition blepharoplasty.”
Blepharoplasty is a surgical option for lower-eyelid rejuvenation, and using fat transfer helps create natural volume out of the excess fat in the area around your eyes. Because hollowing can come with some bagging skin, this makes use of what would otherwise be removed, excess fat.
“In younger people with good skin, we focus mostly on removing or moving fatty tissues,” Dr. Schlessinger says. “This is done by entering the fatty pockets through the inside of the eyelid, also known as a transconjunctival blepharoplasty.”
Unpacking Your Bags
Speaking of bags, Dr. Schlessinger says that a common cause of under-eye bags is a fatty prolapse, which occurs when the fat tissue around our eyes moves outside of its anatomical bed. This can happen because of age, trauma, or a previous surgery. Sometimes, that fat can migrate low enough and contribute to what’s called a festoon.
“Festoons, also known as malar bags, are pockets of tissue and excess fluid on the lower eyelid/upper cheek area that swell,” Dr. Schlessinger explains. “They can be quite distressing and disfiguring, and unfortunately, they can be quite difficult to treat.”
Nonsurgical options include multiple treatments of a few different types, and usually work best on less severe cases.
“Our standard treatment is laser resurfacing combined with Morpheus Micro-RF treatments,” Dr. Schlessinger says. “I use the Morpheus on a very specific energy and depth setting to better target the festoon. Depending on the severity of the case, this approach may take several treatments to achieve improvement. Other treatments include tetracycline injections and for severe cases they can be surgically removed.”
Surgical de-bagging comes in a couple different forms, too. To avoid complication and improve patient outcomes, Dr. Schlessinger relies on a few specific methods.
“I personally do a canthoplasty on the majority of my patients to avoid the complication of lower eyelid retraction,” Dr. Schlessinger explains. “Also, removing fat from a transconjunctival approach, which makes the incision behind the eyelid, lowers the risk of lower lid retraction.”
How to Know if Surgery is Right for You
During a consultation, your oculoplastic surgeon will be able to determine what treatment avenue is best for you based on both the state of your under-eyes now and the goals you have.
“First, we take an extensive medical history to make sure that a patient is suitable for rejuvenation,” Dr. Schlessinger explains. “Then we take photographs and ask what the concerns of the patient are. We will look in the mirror together, examine current photographs, and sometimes we will also look at older photographs of what the person looked like before they needed rejuvenation.”
You should also consider what you can stand in terms of downtime, especially if you have an important event on the near horizon.
“We always discuss lifestyle and the patient’s ability for downtime,” Dr. Schlessinger says. “For example, filler or neurotoxins typically have little to no downtime, while surgery can have 10-14 days of downtime for recovery. We also ask if there is a special event such as a wedding or reunion coming up to make sure we have enough time for the patient to be fully healed in time.”
If it is decided that surgery is not the best option, there are also a lot of non-surgical options available to you. These options include laser treatments, chemical peels, PRP injections, microneedling with Radio Frequency, dermal fillers and neurotoxins, which can address a variety of concerns and deliver appreciable results.
