Baggy Under Eyes

Dr. Murphy



Those Saggy, Baggy, Naggy Under Eyes!!

By Bill Murphy, MD, Medical Director, Turquoise Springs Medical Spa


From the age of 30 and even into the 80s, the most common question from women and men is, “What can I do about under my eyes?”  I hear, “I hate the bags, sags, dark circles, wrinkles, swelling under my eyes, or I hate looking tired, older, sad, etc.!!” It is a complex area to treat. The causes can be varied, including genetics, aging, medical conditions like thyroid problems, allergies, and high salt diets. In previous articles, I have written broadly about this issue and have received questions and a couple of requests to write in more detail… so here goes.


This complex problem is challenging to treat because of several issues to consider. Every person has different anatomy, symptoms, skin type, heredity, sleep patterns, and lifestyle. If there is a small or more prominent protrusion, the bag can be fluid, a fat pad, or a combination. It can be worse some days than others, and if it is due to allergies or fatigue, it is related to those factors. As a person ages, the skin will become thinner and more fragile, and thus, wrinkled and folded due to the loss of collagen and elastin, as well as thickness and elasticity. Discoloration may be due to blood vessels under the skin, which cause the skin to appear darker or slightly tinted blue. If the filler has been placed into the area in the past, this can also cause a blue or green tint, called a “Tyndall effect,” as light reflects off the filler through the thinner skin. A complete evaluation is essential to determine the best way to design a specific solution for each person’s facial features.


If there is some color distortion, usually a darker tint compared to the other skin of the face, I try to determine the cause. First, I will evaluate for small veins under the skin. If present, the small veins can be quickly closed using a properly applied YAG 1064 laser. The effect is immediate. If patches of pigment due to heredity or hyperpigmentation from injury or sun are present, this is addressed differently. The pigment can be addressed with topical creams and/or IPL light therapy.


If the patient has had filler injected under the eye or into the tear trough, the color may be from a Tyndall effect. I will dissolve the problem filler with the enzyme hyaluronidase, and the result will also be immediate.


Next, we must address the skin laxity, loose skin, and volume loss. I hear from every patient the following. “I know I probably need surgery, but I don’t want surgery.”  Even if I send you for surgery, you will still need improvement of the skin thickness and elasticity and replacement of the volume loss. The surgeon can stretch the skin, move muscle, and possibly replace volume with a fat graft, but the skin will still be thin. How can we accomplish these three goals short of and even after surgery?


I do not use gel fillers around the eyes, and my advice is you should not allow anyone to inject filler around your eyes or tear troughs. I use PRF-Gel, which I prepare from your blood. It is all natural with no additives. It has tissue-stimulating factors, growth factors, exosomes, platelets, and dozens of other natural cytokines. These are naturally in your body to stimulate your body’s cells to heal. I place them in high concentration in the space under your eyes with a small cannula or hollow tube to replace the lost volume around the baggy skin.  The under-eye tissue cells will be bathed in fluid, which urges skin, bone, and fat cells to heal, replace, and renew to create more supple and more elastic tissue.


With this natural “fertilizer” in place, we can use two other superb treatments to stimulate collagen and elastin production, thickening the skin and making it more elastic. My favorite is microneedling, which uses radiofrequency heat applied at intervals over the area to different depths. This is great for all body surfaces, especially the area under the eyes.


Another wonderful treatment to renew and tighten skin is Plasma PenMD. The application of small arcs of heat to the skin in a dot matrix pattern under the eyes contracts loose skin, reduces fine lines and wrinkles, shrinks bags, and induces the production of collagen and elastin. This treatment is ideal for upper and lower eyelids, under-eye skin, and crow’s feet.


Managing the under-eye area requires proper evaluation, a unique plan to fit your needs, and expert execution of the plan using the latest and best tools. If you desire to explore a non-surgical remedy for your problem, call 210-253-3313 for a consultation.






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