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Puffy lower eyelids are not always from fat

Blog post - before after photo puffy lower eye cosmetic

As a facial plastic surgeon, I see many men and women who complain of puffy lower eyelids and bags. These patients are coming to the cosmetic surgery office to improve the appearance of their eyes with eyelid surgery or facial fillers (ex. Restylane®).

Puffy lower eyelids, however, are not always due to excess fat. As we advise all patients, the lower eyelids are very sensitive to many factors, internal and external, and react accordingly. This puffiness can be due to  edema or swelling of the eyelid tissues. Plastic surgery obviously is not the best approach for swelling.

How do I know if puffy eyes are from swelling?
While many patients can tell if lower eyelid bags is from swelling, sometimes a consultation with a physician is required. Eye bags which fluctuate, for example with hormonal changes, is one sign of swelling. Eyelids which are significantly worse in the morning, but get better during the day are another sign of swelling. Patients who complain of looking older “all of a sudden” are also more likely to have swelling than the natural changes that occur gradually with eye fat.

Lastly, one’s eyelid appearance is normally not due to one factor alone, but rather a combination of fat, skin, muscle, bone, and swelling. Your plastic surgeon can help determine to what relative degree each of these factors contributes to your puffiness and then develop a treatment plan.

What causes puffy eyes?
There are many reasons why the eyelids become puffy or swollen. This is a just a partial list of potential triggers. Every patient will have varying degrees of puffiness for each factor. The swelling can also last to a variable degree after the trigger has resolved. Lastly, many factors can be present at the same time.

  • emotional states and crying
  • hormones
  • excess salt and artificial sweeteners
  • excess alcohol
  • fluid retention
  • thyroid condition
  • sinus condition
  • allergy
  • gravity (worse in morning, better later in the day)
  • sleep deprivation
  • local irritation: make-up, contact lens, smoke/dust, etc
  • smoking
  • medication

What is the treatment for puffy eyes?
Once you’ve identified potential factors contributing to your puffy eyes, then consider the appropriate treatment. We may recommend starting some basic remedies, then refer to an ophthalmologist, especially when cosmetic treatments are inappropriate. More Botox or filler injections may not be the best solution when the puffiness is due to swelling. The list below is in no particular order.

  • Apply cold water and ice packs
  • Wash your face to remove make-up, allergens, and other irritants
  • Apply cucumber
  • Avoid contact lenses
  • Massage of eyes, face, and neck, which might help release and drain tissue fluid. Lymphatic massage by a professional can help some patients
  • Stop smoking
  • Drink plenty of water and stay hydrated
  • Avoid excess salt and artificial sweeteners
  • Reduce alcohol consumption
  • Get more sleep and sleep with head elevated
  • Apply anti-aging eye creams
  • Take over-the-counter medication, such as anti-inflammatory or antihistamine

Sometimes plastic surgeons and dermatologists will perform hyaluronidase injections to reduce puffiness, especially if you have had fillers injections previously.

After initiating any treatment, for some it may take several days or weeks to notice an effect. Once your puffy eyelids have been stabilized and treated with home remedies, then one may consider possible cosmetic treatments for further improvement.

The woman in the before/after photographs demonstrate results after filler injections to improve the lower eyelid bags and puffiness. Looking upward accentuates or worsens the appearance of lower eyelid bags and puffiness to show the natural result. Other possible plastic surgery treatments for lower eyelid bags include an eyelid lift with surgery, facial fat injection, or combination treatment.

What have you tried to reduce puffy eyes? Share your thoughts below.

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    Houtan Chaboki, M.D.