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Bye-bye baggage: How to cure dark eye circles and eye bags for good

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Sleep is for the weak. That’s what they all say.

Going to bed in the wee hours at night and then groggily complaining about how we’re perpetually sleep-deprived all the time to our co-workers the next morning (it’s cool to be too busy to sleep, haven’t you heard?) is the norm nowadays.

But here’s the catch: sleeping late often results in us sustaining terrible dark eye circles and ginormous eye bags, making us super-conscious of them in the day. They not only can make us look exhausted all the time, they also have a knack to make us look older than we actually are. [1]

These dark shadows beneath our eyes can be downright ghastly; with puffy, swollen under-eye skin making them even more visible, we can kiss rosy glowing complexion goodbye. Even having good skin won’t be able to make up for it.

Although dark circles and eye bags are rarely a sign of any serious medical condition, it does get distressing if they don’t go away. Whether the result of a sleepless night, fatigue or simply stress, tired eyes have long been a universal beauty woe.

If you feel like you’ve tried everything – from home remedies, lifestyle changes to a whole suite of overpriced eye cream – but your pesky eye bags and dark circles still stubbornly persist, this article is for you. Today, we explore all the dermatological treatments you can try out to get rid of your eye baggage once and for all.

“What are dark eye circles and eye bags?”

Infraorbital dark circles refer to the skin under the eyes appearing brown or bluish gray (due to melanin deposition, hyperpigmentation); bluish color (due to transparent thin under-eye skin and visible dermal capillaries); dark and shadowy (due to skin laxity and bulging contours of eye bags). [2]

Under-eye bags, on the other hand, refer to the puffy and swollen skin under the eyes. Commonly associated with fluid retention, our puffy eye bags are often the worst in the mornings and resolves itself by midday as the accumulated fluids drain away with gravity and time.

“Why do we get these pesky under-eye dark circles and bags?”

Of course you’re tormenting your skin (and yourself) if you don’t get enough sleep for long periods of time. It’s the same with not drinking enough water and not feeding our bodies with a nutrient-rich diet, causing our bodies and skin to be dehydrated and undernourished. Our under-eye skin is one of the thinnest and most delicate skin on our body and thus it sustains significant visible deterioration.

This is also why our eye area is amongst the first regions to show signs of ageing. Any swelling and discolouration around the eye area can be quite prominent, resulting in what is commonly known as puffy eyebags and dark eye circles. Think: eye wrinkles, crow’s feet, saggy skin, droopy eyes, eye bags, etc. As we age, our muscles tissues supporting our upper and lower eyelids and facial structures weaken, resulting in loose or saggy skin. This in turn causes fat and fluid deposits to accumulate as eye bags under our eyes. [3]

Contrary to popular belief, fatigue and lack of sleep may not be the cause of dark circles and eye bags. Some of us – especially those with darker skin tones – genetically produce more pigment around the eye area, causing the surrounding skin tone to become darkened. [4]

To tackle your under-eye skin problems at its root, try and determine what really causes your eye bag or dark circles to form. Experiment with at-home remedies and see if they work for you. Sometimes, cold compresses can do wonders to alleviate puffiness and skin tone.

Hello panda-eyes

Some of us – despite our best efforts – have little success in our battle with under-eye dark patches and eye bags, earning a rep as “panda-eyes”. Instead of wringing our hands in helplessness, we can seek aesthetic treatments that can really nip the problem in the bud. After all, our under-eye woes will only get worse as we age!

“How to cure dark eye circles and eye bags (and no, the answer is not Botox!)”

It is true that it seems like all facial woes – wrinkles, crow’s feet, etc – can be “Botoxed” away; but when it comes to our delicate lower eyelid area, did you know that Botox injections have been known to cause side effects such as swelling and even cause eyebags to worsen?

Generally, mild eyebags and dark circles can be treated with fillers, ultrasound treatment, radiofrequency facelift procedures; while severe eyebags may require surgery. Let’s take a look at each technique in detail.

1. Dermal Fillers

A hot derm favorite, fillers made with hyaluronic acid – a naturally occurring substance in our bodies – have been exploding in popularity over the recent years due to their ability to keep the skin supple and hydrated.

woman undergoes dermal filler to treat dark eye circle

Brands: Made by the same medical company behind the wildly popular Botox, Juvederm fillers are amongst one of the most popular brands of hyaluronic acid fillers. Other brands include Restylane, Captique and Hylaform. [5]

What is it: Dermal fillers are soft, gel-like substances which are injected into the skin to rejuvenate, smooth and plump the skin. Unlike botulinum neurotox in Botox, hyaluronic acid is a naturally occurring sugar molecule found in our bodies. [6] They bind water, act as a lubricant, transport nutrients and regulate the water balance in our skin. Hyaluronic acid helps our skin achieve a natural, youthful look; unlike Botox, they do not cause the loss of ability to contract facial muscles.

Able to treat: Eye bags, hollowness under the eyes (in the tear trough), hereditary dark circles. Typically the treatment of choice for non-surgical eye bag removal.

Who administers the treatment: Board-certified dermatologists, aesthetic surgeons. Although hyaluronic acid fillers (and other fillers, for that matter) are not considered surgical procedures because you don’t go under a knife, they do involve micro injections into our skin so you can’t really order it up at your regular facial session.

How are fillers done: First, a topical numbing cream will be applied so that you won’t feel much more than a bit of a ‘sting’ during the injection. Next, the hyaluronic acid filler is strategically injected into your tear trough area.

Obviously we don’t want to “fill out” the bags themselves, but the best thing about fillers is that they are able to treat very targeted areas. For example, the doctor can use fillers to create a smoother transition between the eye and cheek area to minimise the appearance of your eye bags.

It only takes about 10 to 15 minutes if you’re only treating your under-eye area and you will be able see the results instantaneously. [7] There is literally no downtime and you can return to work directly after receiving filler injections. You do have to refrain from physical activities and exposure to sunlight or heat for around 24 hours after the procedure.

Possible side effects: Swelling, redness, bruising, itching, lumps, mild facial asymmetry are temporary side effects. Fillers and injectables done by board-certified dermatologists and aesthetic doctors in Singapore are safe and non-invasive.

Frequency of treatment: The effects of dermal fillers are not permanent but are long lasting. In other words, your plump and hydrated skin can last for about 9 to 12 months!

Cost: Prices start from S$600 to S$1,000 per syringe of 1cc for a HSA-approved brand of filler.

A word of caution: There are many unlicensed fillers that have sprouted up in the market, including Singapore. If prices are too low, check that you are receiving a fresh syringe and a HAS-approved filler product (Juvederm, Restylane)!

2. HIFU – Ultrasound treatment

woman undergoes hifu ultrasound treatment to treat dark eye circle

What is it: Also known as High-Intensity Focused Ultrasound, HIFU uses focused ultrasound energy to reach deep into the skin (up to four layers of skin) and deliver heat. The heat stimulates collagen and elastin production under the skin, tightening and lifting your under-eye saggy skin. It can also help with thinning under-eye skin with restored collagen after treatment. In this way, collagen production is boosted in the superficial dermis, deeper skin layers and the superficial muscular aponeurotic system, working the skin from the inside-out. [8] 

Brands: Ulthera, Ultraformer 3, HiQueen

Able to treat: Eyebags that are caused by skin laxity, saggy or loose under-eye skin, fatty deposits

How is HIFU done: Topical anaesthesia is applied to the treatment area for 30 minutes. Next, the doctor uses a HIFU machine (of which the most common and popular is the Ultraformer 3 HIFU) to deliver focused ultrasound waves via the transducer handpiece. The ultrasound energy generates heat to “melt” fatty deposits and tighten the under-eye skin.

No injections are required and the treatment safe and non-invasive. For eye bag treatments, the treatment is targeted at about 2.0 mm deep in skin layer. It takes about 20 to 30 minutes to treat both eyes and the experience is likened to “tiny ant bites.” The results look very natural and can be seen after 3 to 6 months as your body generates increased collagen.

Who administers the treatment: Board-certified dermatologists, aesthetic surgeons.

Possible side effects: Aching feeling, itchiness, redness are temporary side effects that may be experienced for up to one week post-treatment.

Frequency of treatment: The effects can last for one to two years, with increased levels of collagen in your skin.

Cost: Price of a HIFU session starts from S$500 in Singapore for eye bag treatment.

3. Radiofrequency (RF) energy treatments

cosmetology plastic surgery beauty concept

What is it: Radiofrequency (RF) energy breaks down the orbital fat pads in the lower eyelid area without surgery. Using micro-needles to deliver uniform radiofrequency (RF) energy and heat into the skin around the eye to a depth of around 1.5 mm, causing the under-eye fat deposits to melt away. This process also stimulates collagen production in the skin, resulting in a tightening and smoothening effect. 

Brands: Agnes, Thermage CPT, Infini, EndyMed 

Able to treat: Fatty deposit build-up as under-eye bags.

How is radiofrequency treatment done: Topical numbing cream is first applied and a local anaesthesia is also injected to numb the treatment area. The microcannula (fixed depth needle) is inserted into the orbital fat pad of the eye bag. This delivers RF technology precisely without causing injury to surrounding tissue. The whole treatment for under-eye bags for both eyes takes about 60 minutes. For those who are more pain intolerant, do note that radiofrequency treatments can be considered painful as it is often likened to “a series of rubber band slaps on your skin”! However, a RF energy treatment session can see more visible results than a HIFU session.

While dermal fillers are a great way to “hide” the appearance of eye bags by filling out the sunken and hollow areas and evening out surface under-eye skin, RF technology targets the structural facial changes that causes the eye bags.

Who administers the treatment: Board-certified dermatologists, aesthetic surgeons.

Possible side effects: Redness and red prick marks may be visible for up to a week. There will also be noticeable swelling which will also take up to a week to fully resolve. Occasionally, bruising may develop and it should heal in one to two weeks.

Frequency of treatment: It takes one or two sessions to cure your eye baggage for good and results can usually be seen one month after each session.

Cost: Price of a RF energy treatment session starts from S$1,000 in Singapore for eye bag treatment.

4. Fractional Laser treatment 

woman undergoes fractional laser treatment to fight off dark eye circle

What is it: The laser delivers energy to shatter pigmented cells in your under-eye area without damaging surrounding tissues. Fractional laser treatments also work by burning away certain parts of the surface skin, causing the ablated skin to be stimulated to grow new skin and collagen. Over time, this results in a smoother, younger skin. 

Brands: Pico laser

Able to treat: Dark eye circles.

How is a laser treatment done: After numbing the area, a micro-needle is injected at the lower eyelid and a laser fibre is inserted via it into the eye bag. The laser beam disrupts the pigment granules slowly and hence improves the dark circles. The Pico laser can remove very stubborn pigmentations like melasma, freckles and hyperpigmentation. The process takes about 20 to 30 minutes.

Who administers the treatment: Board-certified dermatologists, aesthetic surgeons.

Possible side effects: Mild redness

Frequency of treatment: Usually four to five sessions would be required, and it needs to be repeated every year.

Cost: Price of a fractional picosecond laser treatment starts from S$450. 

5. Threadlift

What is it: Threadlift basically inserts threads under the skin of about a 3 to 5 mm depth, creating an instantaneous lifting effect. A minimally invasive treatment, a threadlift procedure lifts and tightens the sagging tissue in eye bags, minimising the appearance of those bags.

Brands: Silhouette Soft (threads made of Poly L-lactic acid (PLLA); Ultra V Lift, ART Lift, Duo Lift, Nova – ultra fine threads made of Polydioxanone (PDO). Pro tip: Make sure you are getting absorbable threads. 

Able to treat: Eye bags, puffy eyes

How is threadlift done: The treatment area is first numbed with a topical cream. The doctor then inserts 10 to 12 threads through a mirco-needle or cannula, and begin reshaping the tissue by hand to obtain the desired lifting effect. The non-inserted ends of the threads are then cut off. The threads gradually dissolve over 6 months, leaving no residual material behind and are not harmful to the body. More invasive than fillers but considerably less invasive than surgical blepharoplasty, a threadlift can be done in 30 minutes, hence dubbed “lunchtime facelift”.

Who administers the treatment: Board-certified dermatologists, aesthetic surgeons.

Possible side effects: Facial asymmetry, thread migration, bruising and swelling are possible side effects of a face lift.

Frequency of treatment: The visible effects of an eyebag threadlift can be seen within 3 to 6 months, as your skin generates new collagen. The effects last for 12 to 24 months; after which, you may have to repeat the procedure.

Cost: Starts from $600 and up for an eye bag threadlift.

6. Surgery: Lower Blepharoplasty

Alas, sometimes there’s only so much fillers and medi-facials can do. For very severe eye bags i.e. lots of excess or loose skin that needs to be cut away, lower eyelid blepharoplasty surgery would be your only option if you’ve set your mind to remove ‘em bags for good.

What is it: Lower blepharoplasty is a surgical procedure of removing saggy or baggy under-eye skin.

Able to treat: Eye bags, puffy eyes

How is lower blepharoplasty surgery done: Before surgery, the surgeon first makes markings on the under-eye skin with a surgical pen. The procedure can be done under local anaesthesia.

The surgeon first makes a small incision along the natural folds of the lower eyelid. Then, he begins to remove excess fat deposits in the under-eye bag. He then sews the skin back with tiny, dissolvable stitches. [9]

Who administers the treatment: Surgical eye bag removal is performed only by plastic surgeons in Singapore. The under-eye area comprises delicate structures, including eye muscles and the eyeball itself, so it requires a skilled surgeon to precisely carry out the procedure.

Possible side effects: Swelling, bleeding, infection, scarring. Vision loss is possible but rare with a skilled specialised surgeon.

Frequency of treatment: Once. Lower eyelid surgery is a permanent solution to eye bag woes.

Cost: In general, you will be given eye drops, creams and cold compresses to apply on the area to aid healing. You should also avoid strenuous exercise for one to two weeks and avoid exposure to harsh sunlight as you recover. Do expect some swelling and discomfort during the first few days of recovery. [10]

References

[1] Nguyen, H. T., Isaacowitz, D. M. and Rubin, P. A. (2009). Age- and fatigue-related markers of human faces: an eye-tracking study. Ophthalmology, Feb;116(2):355-60. doi: 10.1016/j.ophtha.2008.10.007

[2] Roh, M. R. and Chung, K. Y. (2009). Infraorbital dark circles: definition, causes and treatment options. Dermatologic Surgery. Vol. 35, Issue 8, August (2009). https://doi.org/10.1111/j.1524-4725.2009.01213.x

[3] Goldman, J. G. (2016). Why do we get bags under our eyes? Retrieved from BBC Future Online, https://www.bbc.com/future/article/20160803-why-do-we-gets-bags-under-our-eyes

[4] Vrcek, I., Ozgur, O., & Nakra, T. (2016). Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. Journal of cutaneous and aesthetic surgery9(2), 65–72. doi:10.4103/0974-2077.184046

[5] Gold, M. H. (2007). Use of hyaluronic acid fillers for the treatment of the aging face. Clinical interventions in aging vol. 2, 3 (2007): 396-376. doi:10.2147/cia.s1244

[6] Liu, K. (2019). Dermal fillers: The good, the bad, and the dangerous. Retrieved from Harvard Health Publishing, Harvard Medical School, https://www.health.harvard.edu/blog/dermal-fillers-the-good-the-bad-and-the-dangerous-2019071517234

[7] Facial fillers and injections. Retrieved from American Academy of Facial Esethetics, https://www.facialesthetics.org/patient-info/facial-esthetics/wrinkle-treatment/facial-fillers-injections/

[8] Chia, V. (2018). Lunchtime beauty fix: medi-facials that take less than an hour. Retrieved from CNA lifestyle, https://cnalifestyle.channelnewsasia.com/style/medi-facial-fast-lunch-time-no-downtime-under-60-minute-10780806

[9] Holds J. B. (2010). Lower eyelid blepharoplasty: a procedure in evolution. Missouri medicine107(6), 391–395.

[10] Kotlus, B. (2019). Lower eyelid blepharoplasty. Retrieved from American Academy of Ophthalmology online, https://eyewiki.aao.org/Lower_eyelid_blepharoplasty

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