Puffy Eyes and Dark Circles

I have puffy eyes with dark circles under them, and everyone always says I look tired. What can I do?


There are usually four components that make up the appearance of puffy and tired looking eyes.

1. Dark pigmentation of the skin under the eyes. Usually genetic.
2. Fine lines and wrinkles throughout the lower and upper lids - "creppy" skin.
3. Bulging of the skin under the eyes caused by fat tissue that is "pooching" out.
4. "Tear trough" under eye area indentation caused by loss of volume with age in people that are genetically prone to having this problem. A shadow falls into the indentation, causing the dark circles that give a tired appearance.

Loose upper eyelid tissue that overhangs the eyelid is another element in making the eyes look tired, but we're concentrating here on the lower eyelids.

1. Not alot that can be done about this. Bleaching creams with hydroquinone or kojic acid sometimes help.
2. The only solution to this issue is laser treatment. The only laser that I have seen that actually makes any difference in under eye wrinkles is the Active Fx. The treatment is quick and easy, with about 4 days of downtime. Results are dramatic.
3. This is usually a surgical issue. If there is a large amount of bulging, only blepharoplasty with fat repositioning will really help. However, if there is only a small to moderate amount of bulge, I usually use Juvederm under the bulge to camouflage the appearance. If you raise the skin under the bulge with a filler like Juvederm, filling in the valley underneath the bulge, the observer no longer sees the bulge. Its a bit tough to explain - I have lots of examples on my website.
4. This is the situation that is most common in my practice. Time and genetic predisposition cause an indentation in the "naso-jugal groove" (the area underneath the lower eyelid), a shadow falls into the groove and the person's eyes appear tired. This is easily corrected with a hyaluronic acid filler. I prefer Juvederm because it is smooth and lasts for over 1.5 years in that area. This is a technically difficult procedure and should be done by experienced injectors only, so if you're thinking of having this procedure done, you should certainly find out how many the doctor has performed.
Aside from filler there lasting 3 times as long as any other area, the otehr unique quality to the under eye area is that it is pretty much painless. The skin doesn't seem to have alot of pain nerve connections.