Why Sudden Puffy Eye Bags with Existing Medical Conditions are Best Treated Non-Surgically First

Author: Amiya Prasad, M.D.

Sudden under eye bags! From my ill health or bad luck? Are fillers viable for minor bags? I am 33 years old and healthy. I have no family history of bags. 5 viruses this year left me with colitis, and now petrositis. I was anemic and now have low iron. My eye bags came on quickly in May while on birth control.

I stopped because but I still had bags. I was on prednisone 2wks in June and bags went away! But it came back after stopping meds. Does this mean they are not fat but rather fluid or inflammation? Could petrositis indirectly cause this? Anemia? Are fillers a viable option until surgery can be afforded? Thank you for your question! Your question about sudden under eye bags and you revealed a medical history which certainly can be factor in the appearance of your facial appearance as well as having possibly a contributing factor to the progression of the under eye bags.

So, let me just give you an idea of what we do in our practice. I’m a cosmetic oculofacial plastic surgeon specializing in this area for almost over 20 years and I can tell you that many people come to us with different variations of a story like yours. Now you had recurrent viral infections and you’ve had petrositis and certainly stress when comes to this, it becomes almost like a common factor of a significant physical stress that can potentially contribute to the under eye bags. Now, the best way to figure out whether these puffy under eye bags are going to be there long term versus having variability is to understand first the anatomy. So what are the bags under the eyes? The bags under the eyes represent lower eyelid fat prolapse. Lower eyelid fat prolapse means the fat that is normally around your eyes pushes forward.

Now most of the time, even with a clinical history of sinus issues, allergies, sinus surgery, other related things or factors that can cause facial swelling, there is often still a hereditary factor. Now if it doesn’t run in your family, that may be just something to factor in when you’re thinking about your management. But, when people first notice under eye bags in the absence of a history like yours, they always mention that they have some good days and some not so good days. And as time goes on, they tend to have not so good days most of the time and that means that the puffiness is always present. Now given your current medical situation that’s still evolving especially with the anemia being a factor, it think that it is not unreasonable to consider a nonsurgical option such as the use of a filler like a hyaluronic acid. In our practice for under eye pockets that are very early and minimal, we do perform the application of hyaluronic acid such as Restylane placed into the tear trough area to try to soften the transition between the puffy bags and the valley underneath which makes the puffy bag look more puffy. A lot of times, a lot of doctors will be a little overzealous and try to fill in the area when someone has to much prolapse fat and then it just look terrible.

Why Sudden Puffy Eye Bags with Existing Medical Conditions are Best Treated Non-Surgically First

Now you should also be mindful that hyaluronic acid fillers can also cause swelling. So the approach should be relatively conservative if you are going to try that first. In our practice, we commonly combine hyaluronic acid fillers with platelet-rich plasma. Platelet-rich plasma is derived from your own blood and it is the concentration of the healing and growth factors necessary for wound healing that helps improve the skin quality and acts very well in synergy with hyaluronic acid.

Again, with the issue of your medical history still influx, I think conservative measure are probably best explored rather than moving forward directly with surgery but at the same time, it is probably your benefit to not do any kind of intervention and observe whether or not the fat pockets are consistently there for weeks at a time so you could at least have a sense of the constant nature of the fat pockets being present. So again to summarize, suggesting that you consider a non-surgical option such as the use of hyaluronic acid filler to fill the tear trough after establishing that regardless of your physical health, whether it’s the viral issues, the recurrent infections, the petrositis, all those issues being relatively stable and the puffiness remains, then moving forward with a non-surgical intervention is probably worth exploring. So I hope that was helpful, I wish you the best of luck and thank you for your question!.

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