Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 1/10/2021
When you wake up feeling well-rested, the last thing you want to hear is that you look tired. But as we age, our bodies start to change — in good ways and bad. One of the less graceful aspects of growing older is skin aging.
Under-eye bags tend to be the result of this loosening skin under and around our eyes, and are a common occurrence that often result in the appearance of puffiness.
Under-eye bags can be attributed to several factors, from skin elasticity and the aging process, to the way your bone-structure influences your facial features, to a number of external factors.
There are several concealment options, as well as minimally-invasive or surgical alternatives to hide or get rid of under-eye bags and brighten your appearance.
A significant reason you see under-eye puffiness is due to the aging process and the natural loosening of the skin, causing your face to change shape and position.
As you age, the tightening of ligaments around your eyes leads to relative inflexibility of the ligaments, which causes hollowing that leads to a shadowing effect.
Due to the thinness of the skin under the eye, it is also difficult to hide blood vessels or the vascular network within the under-eye skin, which may lead to visible dark circles that are sometimes seen with under-eye puffiness.
Sometimes the dark circles you see are just due to shadowing caused by the prominence of the tear trough. Others, however, are caused by the natural stretching of the skin, and are more difficult to mask.
Sun exposure, diet, smoking and stress are all other common factors in the appearance of under-eye bags. All of these factors have been linked to premature aging of the skin and can accelerate the natural aging process, perpetuating the appearance of under-eye bags.
Repeated exposure to UV radiation causes visible change in texture and color of the skin, which are both inherent features of under-eye bags. Consistent exposure to the sun damages the skin creating a rougher texture and leading to fine lines (rhytids) which can create larger folds and wrinkles.
Smoking can dehydrate the skin causing aging effects to become more dominant in the skin, as well. Smoking decreases collagen production and has similar effects on the skin as the effects seen by chronic sun exposure.
Diet also plays into the appearance of under-eye bags. Diets high in sugars like glucose and fructose can negatively affect the appearance of under-eye bags by prematurely aging the skin. Sugars accelerate the aging process by reducing elasticity in the skin and increasing stiffness to promote sagging of the skin and deeper wrinkles through changes in collagen and elastin fibers.
Research also shows that in some instances, under-eye bags and shadowing can even be hereditary.. In cases of under-eye bags, they may range from moderate to severe, depending on what the rest of your family looks like. Either way, there does appear to be a definitive genetic link.
Under-eye bags can also be attributed to certain medications, like oral contraceptives, and can even be linked to conditions, such as contact dermatitis, melasma and even excessive exposure to sunlight.
Treatments for puffy eyes have been touted by social media influencers, beauty bloggers and celebrities for years, and we’ve heard a little bit of everything — cold spoons, hot tea bags, a cucumber slice or two.
Treatments for puffy eyes have been touted by social media influencers, beauty bloggers and celebrities for years, and we’ve heard a little bit of everything — cold spoons, hot tea bags, a cucumber slice or two. But what actually works?
The least invasive methods to hiding under-eye puffiness include cosmetic concealers. Cosmetic concealers can be relatively inexpensive and bought at most convenience stores, supermarkets, or beauty stores.
A recommended concealment method is to use opposite color wheel concealers, such as using a green concealer for reddish-brown under-eye bags to neutralize the appearance of the circle and disguise it.
Retinoids are another topical option to reduce the appearance of under-eye bags and are used to promote collagen synthesis and improve skin quality. Retinol is a derivative of Vitamin A and helps to inhibit depletion of collagen enzymes by UV rays.
Retinoids, like moisturizers and eye-creams containing retinol, decrease melanin content and increase skin smoothness, while reducing discoloration of the area around the eye. The combination of collagen production and melanin depletion reduces the size and appearance of under-eye bags.
As of now, the FDA has only approved two retinoids as anti aging drugs-- one that helps synthesize collagen decreases depletion of elastin (tretinoin) and another that improves wrinkles and discoloration (tazarotene). Consider introducing a retinol eye-cream or lotion into your skincare routine.
While it may not be a magic treatment, an important deterrent for under-eye bags, as well as all facial aging signs, is sunscreen. While chemical sunscreens can be damaging to the sensitive skin around the eyes, broad spectrum SPFs or UV protective sunglasses are considered beneficial to reducing any damage to the under-eye area.
Caffeine-based gels can also be applied to reduce the appearance of dark circles. Topical caffeine may help reduce the appearance of excessive formation of blood vessels in the eye (subcutaneous vascularisation) and penetrate the area to neutralize under-eye discoloration.
However, experts do recommend the tried-and-true methods that may be more accessible:
A cold compress around the eyes, such as a washcloth, while applying pressure and sitting upright.
Sleeping with your head elevated or raised, perhaps adding an extra pillow to avoid fluid buildup around your eyes.
Avoiding salty foods in your diet and fluids before bed can help with fluid retention.
Quitting smoking can help with dark circles, as smoking contributes to the loss of collagen and can cause further thinning of your under-eye skin.
Make sure you get enough sleep — generally between seven and nine hours daily.
Although it may be more accessible to use non-invasive treatments, there are various methods that are a bit more long-term and require medical assistance.
In 2016, eyelid surgery was the fourth-most common type of plastic surgery and in 2017, soft-tissue filler was the second-most performed non-invasive procedure in the United States.
There are several options if you opt for this route in treating your eye puffiness.
Hyaluronic acid fillers are a commonly used option for many procedures in order to reduce the appearance of aging and restore volume to the face, and are also a common method to reduce the appearance of under-eye bags.
Although hyaluronic acid may sound a little intense, it’s actually a naturally occurring substance that’s made within the body and is crucial in the hydration and lubrication of joints. Hyaluronic acid is found in all tissues and fluids of the body and is extremely important in hydration of the skin and has the capacity to bind to and retain water molecules, which can maintain the elasticity in the skin.
As we age, hyaluronic acid levels begin to decrease in the outer layer of skin (epidermis), which produces HA at a lower rate in general, while continuing production within the inner layer (dermis). Premature skin-aging is due in part to exposure to UV rays, and reintroduction of hyaluronic acid into the outer layer of skin can temporarily subdue that damage.
Fillers are widely available and can help in addressing volume deficiency under the eyes by filling directly into the ligaments around the eyes and creating a less hollow appearance. Their main function is to reduce the appearance of shadowing under the eye and contour irregularities.
Choosing fillers is an easy option to reduce under-eye bags as it’s a simple procedure that can be reversed if necessary. With the introduction of enzymes that degrade hyaluronic acid (hyaluronidase), fillers may be reversed if they produce undesired results.
Chemical peels are resurfacing treatments that can aid in the improvement of collagen conditions in the skin and can also aid in the reduction of melanin. This treatment specifically targets melanin production but affects both discoloration in the skin as well as addressing wrinkles and uneven skin texture.
Chemical peels can be administered in different concentrations, which can result in a variety of outcomes. The peeling agents specifically alter melanin content and a deeper peel can reach farther into the skin to adjust melanin issues below the surface.
Peeling treatments can be used alone or in combination with bleaching agents to reduce the appearance of dark circles. Since bleaching agents may be used and chemical peels tend to target pigment irregularities, those with darker skin tones must take extra precaution with this option as it may cause more complications with discoloration.
While treatment of under-eye bags may allow a chemical peel to be concentrated toward the eyes, those with darker skin tones may opt for a peel that would extend over the entire face to avoid a distinct line between where the procedure is done and the non-affected skin.
Many patients who opt for chemical peels may, however, find themselves with a temporary unwanted side effect. After a peel, the affected skin may become inflamed and discolored (postinflammatory hyperpigmentation) for a period of time. Luckily, this can also be treated.
Another resurfacing alternative would be to undergo laser resurfacing, which is a treatment that improves the tightness of the skin, collagen production and the appearance of blood vessels underneath the eyes. Essentially, laser resurfacing works by creating low-level skin damage that results in the creation of new skin with less damage and more collagen production. It encourages the reparative process in the skin across the face and beneath the eyes, which decreases skin discoloration and treats fine lines.
Laser resurfacing is generally executed by one of two options: full ablative lasers or fractionated laser technology. While full ablative lasers may produce the best, most effective results, fractionated laser resurfacing leaves behind new skin that has a lower rate of complication. Although both types of laser treatment are comparable and effective, fractionated laser treatments require less downtime.
Depending on the underlying cause of under-eye bags, some people may opt for a surgical procedure called a blepharoplasty. Surgical blepharoplasty is performed in order to restore function and aesthetic appearance of the eye and is performed by both the ophthalmologist and a plastic surgeon.
Blepharoplasty is an outpatient procedure that involves the surgical removal of fat near or around the upper eyelids, that is then injected into the lower eyelids. The excess skin is removed and the underlying muscles are smoothed in order to eliminate the sagging that typically occurs with under-eye bags. Ultimately, the supporting structures around the eye are tightened and fat is repositioned to create a smooth under-eye area.
While chemical peels and laser treatments are more effective at treating discoloration and pigmentation issues, a blepharoplasty is sometimes used to treat shadowing effects caused by under-eye puffiness. However, this procedure is a bit more invasive than any of the alternative methods. It’s essentially a fat transfer and transposes fat from around the upper eye to the hollow space below.
This procedure is best suited for those candidates whose dark bags are caused by gravitational and age-related reasons. When the under-eye skin begins to sag, the skin’s elasticity begins to deteriorate, which is what a blepharoplasty hopes to correct in addition to aesthetically fixing under-eye bags.
Due to the complications that may arise as a result of this procedure, this technique is a bit more serious than that of laser resurfacing or chemical peels. A pre-operative appointment will assess if you can safely undergo a blepharoplasty, but complications that can arise afterward can include, but are not limited to:
Infection and bleeding
Excessive scarring or asymmetry
Drooping or swelling
Double vision or loss of vision
For optimal results, a blepharoplasty may be performed in conjunction with a chemical peel to further reduce the appearance of under-eye bags. While a chemical peel can directly impact the darker pigment, the blepharoplasty can address the sagging of the skin to reduce or eliminate under-eye bags.
Under-eye bags are more of a cosmetic hardship than a difficult medical condition.
Nevertheless, they can be enough to make you feel less confident and affect your quality of life. Although concealing or treating under-eye bags isn't a cure-all, it may assist in your overall emotional well-being to feel better about your physical appearance. Luckily, they’re easily treated or concealed with the help of a number of invasive or non-invasive methods.
While we can’t avoid the physical effects of the aging process, there are ways to lessen the degree and rate at which they happen.
For under-eye bags specifically, some of the methods up for consideration include everything from using the right concealer, to adding a retinoid to your skin care routine or even opting for surgery.
As always, don’t hesitate to contact your healthcare provider. Depending on the severity of your under-eye bags and how they make you feel, your healthcare provider or certified dermatology practitioner will have a solution that’ll fit your comfort level.