Bye-bye, under-eye bags

How your eyes see is critical but how your eyes “look” is equally important. Bright, sparkly eyes make you appear friendly, lively and enthusiastic. Even if you are feeling that way, you may look tired, old and unwell, if you have dark circles or under eye bags. Let us understand why this happens and the ways to remedy it.

Why we develop under-eye bags?

One cause, experts say, is natural ageing. With age, the muscles in the eyelids weaken and the collagen too starts degrading, leading to wrinkling and sagging of the skin. Collagen is responsible for giving structure to our cells and maintaining the tautness and elasticity of youthful skin. Besides skin and muscle, another culprit for under eye puffiness is fat. As one gets older, the ligaments that hold the fat layer get weak, allowing the fat to push forward, forming a little puffy pillow under the eye. However, recent research discounts this theory. Instead, the amount of fat beneath the eyes actually starts to increase with age, causing baggy lower eyelids. More research is needed to determine the exact mechanism that leads to baggy lower eyelids, but it is universally agreed that as the calendar pages turn, the bag-forming process naturally progresses.

We all age but why do only some of us develop under-eye bags?

Like with most of our characteristics, heredity plays a major role in this too. Those who have a family history of this develop this problem sooner or to a greater extent than others. Apart from the genes we inherit, lifestyle factors matter too. Do you consistently deprive yourself of sleep? Do you eat a lot of salty food that causes you to retain water? Are you getting enough exercise? Inappropriate lifestyle choices invariably reflect on your skin and may hasten the process of developing dark circles and under eye bags.

Can some other conditions masquerade as under-eye bags?

Yes. Under eye puffiness can also be a result/symptom of a medical condition such as chronic sinusitis. Those with sinus trouble often experience swelling around the eyes. The process of blowing up of the skin and then reverting to normal keeps happening all the time and can loosen the skin. Over a period this lead to bags under your eyes. So if you’re experiencing symptoms of sinusitis [pain in cheeks and brow, puffy and watery eyes] take precautions to avoid this in later years. You can use an extra pillow or a wedge that props up the head to help create some drainage and this might make the eyes look less puffy in the mornings. Sudden swelling of both upper and lower eyelid points towards a severe allergic condition known as angioedema. This may or may not be associated with itchy hives on the skin. Hypothyroidism or low levels of the thyroid hormone may present with bagginess of lower eyelids along with dry skin, frizzy hair, sallow complexion and menstrual irregularities. Finally, if the puffiness below the eyes changes with posture or the time of the day you need to rule out renal or cardiac causes.

Do home remedies work?

Using cucumber slices, ice-packs or frozen tea bags help, but only for a short while. These home remedies seem to work mainly because of the cold temperature that has an anti-inflammatory effect and temporarily reduces swelling. Amongst all the home remedies, using green tea bags works the best as green tea contains a natural anti-inflammatory ingredient known as EGCG that reduces fluid retention responsible for puffiness.

What are the medical options to treat under-eye bags?

Medical/cosmetic therapy aims at not only improving the puffy lower eyelid but also to rejuvenate the appearance of the skin around the eyes. This can be achieved with temporary measures like Botulinum injections or dermal fillers.

Botulinum or botox, a protein derived from the bacterium Clostridium botulinum, when injected into muscles leads to temporary paralysis and flattening of the muscles. It stretches the overlying skin and results in smooth, wrinkle-free appearance. It is often used to iron out the wrinkles around the eyes commonly known as &lquo;crow’s feet&rquo;. The maximum effect is seen 1 or 2 weeks after the procedure and lasts for 3 – 6 months. If performed by trained hands, it is a safe and effective measure to give a youthful look. If the injection is placed in the wrong muscle or in excess, it may lead to temporary drooping of the eyelids.

The other option is to use injectable dermal fillers to fill up the tear trough. The tear trough is the junction of the lower eyelid and upper margin of the cheek. The filler is injected just under the puffy area to even out the look and remove the indentation caused by the puff. The commonest filler agent used is hyaluronic acid. This is a natural component of the dermis, which binds water and renders volume and turgidity to skin. Dermal fillers work well in early stage puffiness and bags. The result lasts for 6 –9 months and then the procedure has to be repeated.

Surgical eye lift offers a more permanent solution. In one surgical intervention, the fat under the eyes is melted with the help of tiny electronic probes. Another surgical method is blepharoplasty. In it, the under eye fat is removed along with loose skin either with the help of a scalpel or laser. This corrects both drooping and sagging. In either case, the surgeon makes a small incision in the skin around the eye to remove excess fat. Often, the surgery is done on upper eye lids as well.

Another option is transconjunctival lower lid blepharoplasty, which is a procedure to remove excess fat from the lower eyelid through the conjunctiva, thus hiding the surgery marks. The eye lift usually doesn’t require hospitalisation as it can be done in an hour. It heals in a couple of weeks.

Who can opt for these surgeries?

There are certain pre-requisites for the laser correction of under eye bags. An ideal candidate for this procedure should be 35 years or older, physically fit and should be made aware to expect results that are realistic rather than fantastic. Furthermore, a person with pre-existing medical conditions such as thyroid problems, diabetes or high blood pressure is at a higher risk of a difficult procedure and could also expect suboptimal results.

What are the risks associated with surgery?

Eyelid surgery may also be associated with certain discomforting after-effects such as blurred vision or double vision. However, these disappear in a week or so. You need to also factor in some swelling and bruising, which heals in a few weeks. A few patients also develop tiny white heads called milia in the suture line after removal of the stitches. However, these can be easily removed by the doctor.

Certain complications are long-lasting. Some patients have difficulty closing their eyes. This problem generally resolves within a few weeks, although rarely, it can be permanent. Ectropion, a condition that causes the lower lids to be pulled down, is another rare complication that requires surgical correction.

Lastly, conditions such as glaucoma, dry eyes, and detached retinas are rare complications associated with eyelid surgery. One needs to be aware of these potential complications before signing up for the procedure.

This was first published in the November 2011 issue of Complete Wellbeing.