Under Eye Circles and Bags

16 May

Physiology: Broken blood vessels within the lower eyelid. A shadow forms underneath the bag causing the dark circles to appear. As you age, the “bags” (fat pads) can bulge due to gravity, creating an exaggerated space between the skin of the check, and the skin of the eye, over the orbital rim (bone of the eye socket). These dark circles can bring about a chronically fatigued look, or make you appear older than you actually are.

Cause: range from fatigue, vitamin deficiency, hyperpigmentation, allergies, age, and medical conditions. However, heredity is the most common cause for bags under the eye (also, from my patient’s personal experience… I hear children and husbands may also be contributors? It has not been clinically proven however.).


Getting the proper rest and eating the right foods can sometimes help treat and improve dark under eye circles, but if genetic, dark under eye circle will increase if untreated.

Fraxel®, Thermage®, Blue Light Therapy, IPL Photofacial, Dermal Fillers and Chemical Peels (like TCA). Patients with more severe cases of under eye circles, puffiness and loose upper or lower eyelids may want to seek out surgical alternatives including blepheroplasty.

My Best Advice

It is always a good idea to start with the least invasive methods and move on to the most invasive methods. That being said, genetics does play a HUGE role in this, and if your mom or dad has extremely sagging lids, or bulging fat pads, the earlier you do surgery the best result you will have.

Least Invasive to Most Invasive

  1. Hydration: The area of skin under the eye is the thinnest in the body. In a hospital setting, we monitor this area as a sign that a patient could be dehydrated. I can always tell when someone needs fluids just by looking at this clinical sign. Start with drinking water… water is good for your body all around. And… it’s FREE!
  2. Eye Cream: Supply your skin with the nutrients it needs. By depositing certain vitamins and peptides, you can decrease the appearance of dark circles. Before you tell me you’ve tried every cream under the sun… have you read my post on pharmaceutical products? Step 2: Spend wisely.
  3. Noninvasive treatments: Laser stuff. Not my area of expertise, however, I have had IPL on melasma, and it worked great. Laser treatments will help with the discoloration, and may subtly tighten the skin, but they will not fill volume loss. If you have volume loss, see step 5.
  4. Chemical Peels:  Best done in the winter time when you’re not in the sun.  And actually… this is more for fine lines and wrinkles around the eyes than bags and dark circles.  Although it will help the appearance.
  5. Dermal Fillers : (That’s NOT Botox..) A hyaluronic acid of low molecular cross linking like Juvéderm Ultra is most recommended for this area. Thicker fillers, like Radiesse, and biostimulators, like Sculptra, are not recommended for this area. Remember this skin is the thinnest in your body, and thicker products can leave bumps here. Be VERY careful about who you see for this treatment. It is a very advanced procedure that your Dentist or Primary Care probably shouldn’t be performing on you.
  6. Blepheroplasty: Check out my post on Blephs. Observing Surgery: Blepharoplasty.

Dermal Fillers

Dermal Fillers are my area of expertise (Remember photography is also not my thing!!!)

Here’s my Before and After Tear Troughs:

Before: I look tired. And old. Ew. Taken November 2011.

After: As you can see I look more awake and refreshed. Taken February 2011 after I had my tear troughs filled.

I am very happy I did this. Surprisingly, it didn’t hurt at all. The product used was Juvéderm Ultra. It will last about a year. Cost is about $600.


(The two I like best)

Image Max Eye Cream: This next-generation revolutionary day and night eye crème contains high concentrations of growth-factors derived from plant stem cells to protect skin cells and prevent aging effects caused by free radical damage. Reduces the appearance of fine lines and wrinkles; reduces puffiness and inflammation. Prevents cell aging. Contains grape, alpine edelweiss and apple stem cells for maximum age prevention. Corrective peptide blend for rejuvenation. Retails for about $45

Image Vital C: A scientifically- advanced hydrating, anti-aging eye gel. Contains a blend of nourishing anti-oxidants that reduce the appearance of fine lines and prevent the breakdown of collagen. Vitamin K  (Phytonadion) diminishes dark circles. Restores youthful looking eyes. Retails $31

8 Responses to “Under Eye Circles and Bags”

  1. Megan May 16, 2012 at 12:56 pm #

    I had my undereyes done just about a year ago. What a difference!!! I don’t think I could live without juvederm now. I have had dark deep circles my entire life (bad allergies) and this is a cure for that tired look.

  2. anne July 16, 2012 at 9:54 pm #

    Hi there, I visited a Dr who recommended Juvederm Ultra Plus under the eyes, is this what you have? You look great!

    • bostonbeautyblog July 20, 2012 at 1:53 pm #

      I usually use Juvederm Ultra under the eyes. The difference between the Ultra and Ultra Plus is the degree of cross-linking of the product. Juvederm Ultra is less cross linked, making it less hydraphilic (attractive to water molecules). The skin under the eye is the thinnest in the body. If too much product is deposited to the area, it will be bulgey looking (and often does). First I recommend sleep and water, but if you can’t do that, or it doesn’t help, filler is a good option. This is a very advanced procedure, so really check out who you see. I’ve seen some really bad treatments! Fortunately if this does happen, Juvederm can be reversed.

    • bostonbeautyblog July 27, 2012 at 8:15 pm #

      NO! Juvederm Ultra (not Plus) should be used under the eyes. It is not as cross-linked (meaning it doesn’t attract as many water molecules) which means it doesn’t get puffy/plump looking. This area of skin is very thin and requires a VERY small amount of product. The only place I use Juvederm Ultra Plus in the lips.

  3. Valentina Lieto September 25, 2012 at 10:22 am #

    Do I need to remove fat or just to fill? I dont know if my problem is volume loss or too much fat. I’d like to send you a photo, how because I can’t post it here?

  4. Lisa December 3, 2013 at 1:14 am #

    Hey , how are you! You look great!!!!

    So this really works? Bcuz I too have the same problem and I’m soooo tired of buying freaken concealers and having to apply over and over. I don’t mind having to apply it once during the day but it just sucks having dark circles and hollowness!

    You think it’s worth a try and money?


  1. More Belotero! | bostonbeautyblog - February 27, 2013

    […] to take away sleepless nights and stress, but at least I can make it look like I did by improving Under Eye Circles and Bags! I’m so thrilled with this product I did my own under eyes (called the tear trough). December […]

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