The presence of under-eye bags has been one of the most recurrent diagnoses of aesthetic consultations for years. Bags are exceedingly unwanted by both men and women as they give the face a tired-looking and aging appearance. Neither the use of under-eye creams and serums nor makeup help reduce tired-looking eyes. Under-eye skin is 5 times thinner than any other cutaneous part of the face.
This renders the under-eye area subject to external aggressions in different ways. Under-eye circles can be caused by: 1. The formation of bags under the eyes due to fat accumulation, poor lymphatic flow, water retention or hereditary origins. 2. The formation of sunken under eyes due to fat dissolution (caused by aging) 3. The hyperpigmentation of the under-eye area or eyelids due to a poor blood flow. 4. All of the aforementioned symptoms.
Treatments for under-eye bags
The treatment of under-eye bags is generally surgical. Blepharoplasty –also known as eyelid surgery– is a cosmetic surgical procedure of the face, which reduces bagginess from the lower eyelids. For younger patients, the intervention requires a transconjunctival incision since bags have lesser volume and under-eye skin is simply distended. Therefore, scarring will be invisible. For older patients, the intervention requires a conjunctival incision (1-2 centimetres). Upon incision, excess skin and/or fat in the lower eyelid will be removed. Other techniques that combine hyaluronic acid injections to fill creases surrounding the bags or the injection of botulinum toxin around the crow’s feet may be considered. However, they remain less effective and permanent than surgical treatments.
Treatments for sunken under eyes
Sunken under eyes are generally caused by fat dissolution. They can be treated with fillers like voluminazing hyaluronic acid injections or a rejuvenating medical protocol that combines hyaluronic acid injections (to fill creases under the eyes, the temples and the cheekbones) to botulinum toxin injections (removes crow’s feet wrinkles and lifts the brow tail). The effect of these treatments may last between 6 to 18 months and injections must be redone in case of need and provided that the time interval recommended by the doctor is respected.
Treatments for hyperpigmented under eyes
The treatment of hyperpigmented under eyes is delicate as it targets the deep layers of the skin (dermis).
Blue, purple or red under eyes
Blue, purple and red under eyes that suffer from excessive cutaneous thinness (therefore rendering muscles and blood vessels visible under the eyes) may be treated symptomatically by thickening under-eye skin and concealing hyperpigmentation. This can be done through: -volumizing hyaluronic acid injections to render thin under-eye skin thicker -the use of fractionated radio frequency, which releases energy impulses via micro needles. These penetrate up to 1 or 2 mm into the skin (dermis) creating heat that stimulates collagen fibers and a thickening of the skin. The treatment may also be etiologic, which directly acts on blood vessels through a vascular laser application. This treats dilated micro vessels, blue, red and/or visible veins under the skin.
Dark/black under eyes
Dark circles are generally the result of ethnic or hereditary origins. This condition touches people with relatively white skin and also having dark bags (generally caused by accumulation of melanin). Accordingly, people with dark skin also suffer from dark circles as they have a concentration of melanin in the under-eye region. The treatments for dark/black under-eyes can be the following: -soft peelings (glycolic acid, low trichloroacetic, or resorcinol) results in a progressive brightening of melanin pigmentation through the regeneration of newer skin layers. -fractionated laser: it consists of releasing microscopic impacts of vessels which penetrate into the skin (dermis), eliminate melanin (responsible for the dark pigmentation of circles) and stimulate the process of natural scarring for several months. -fractionated co2 laser: its principle is similar to fractionated laser in terms of process and results. However, the former releases carbon dioxide laser impacts and does not affect certain parts of the skin (which will then promote natural scarring by forming a new skin layer). -pulsed light sessions: these have an identical effect to fractionated laser. They help tighten the lids, improve skin texture and smooth peri-ocular and crow’s feet wrinkles. Generally speaking, these treatments are combined with prescriptions of depigmentation creams and sunscreen to obtain optimal results and extend their effect.
Treatments for mixed circles
Mixed under eyes correspond to the presence of sunken circles or bags, hyperpigmentation, wrinkles and scars, etc. The therapeutic protocol should be adapted depending on the medical case and the doctor is allowed to combine several techniques at once to ensure optimal results. Among the techniques that help correct every under-eye imperfection is carboxytherapy. Carboxytherapy injections are supposed to trick the area around the eye into thinking it needs more oxygen, which dilates blood vessels and stimulates increased blood flow in the area. The results are: preventing and improving skin slackening, filling the sunken aspect of circles and correcting unwanted hyperpigmentation. The number of sessions vary between 6 to 8 sessions with an interval of one week between each. There is no actual prevention of bags formation, but it is possible to predict or control their appearance. A healthy lifestyle (healthy eating habits, exercising, and sleeping well) may help in such cases.