Why Tired-Looking Eyes have Different Causes and Solutions for Puffy Eye Bags and Dark Circles

A 36-year-old woman says that people always tell her how tired she looks. She wants to know her options.

Dr. Amiya Prasad, a practicing oculofacial plastic surgeon for over 20 years, says that a lot of people in Manhattan and Long Island who come to his practice say they are tired of looking tired. The eyes project what someone feels, so if someone has puffy bags under the eyes and dark circles, it communicates: fatigue, sadness and lack of energy. He says it is possible that a person has more than one cause of tired-looking eyes, therefore there must be more than one solution. Currently, it’s very popular to use fillers of different kinds, most in the hyaluronic acid family, to help soften the transition between the puffiness underneath the eyes and the adjacent area called the tear trough.

The puffiness is due to lower eyelid fat prolapse, which means that fat pockets that are normally around the eyes pushes forward. It is also called herniated fat, which creates a bulge that also accentuates an adjacent area called the tear trough to make it look more hollow. This makes a person look like they have deep, dark circles. Often there is also volume loss in the eyelid cheek junction or an area called the V-deformity. Genetics, weight loss or a combination will make someone lose volume in this area.

Dr. Prasad says that she could consider a combination approach before considering surgery. Ultimately, the puffy bags underneath the eyes need to be operated on. There is no way to address the fat pockets without performing the surgery. However, she can buy time using a combination of platelet-rich plasma that is derived from her own blood. It is using the healing growth factors necessary for wound healing. When this material is placed under the skin, it improves the skin quality. He then combines that with a filler such as a hyaluronic acid filler like Restylane. There’s a real synergy between the two.

Dr. Prasad says it’s very important to understand that there’s an upper limit on how much volume can be placed in the under the eye area. He has seen patients all the time who have had way too much filler placed by another doctor, so he has to dissolve that filler using an enzyme called hyaluronidase. Sometimes, well-meaning doctors do a very artful job, but they just make the cheeks look so big that a person is almost unrecognizable. An alternative strategy is addressing the fat pockets and then considering adding volume below the area of the fat pockets.

In Dr. Prasad’s practice, he uses a combination of surgical treatment, filler and platelet-rich plasma. He also uses topical creams to help with the superficial issues whether it’s retinoids or good moisturizers, sunblock etc. He has his own skincare product line, but no skincare product can get rid of bags under the eyes. He suggests that she meet with doctors and get some opinions to understand how all of this can be handled. She is going to see a lot of different approaches and she must feel comfortable with the rationale.