DEAR DOCTOR K:
Why do I have bags, puffiness and dark circles around my eyes? What can I do about it?
My Harvard Medical School colleague Dr. Robert Shmerling wrote about this a couple of years ago in the Harvard Health Letter newsletter. Here’s some of what he said:
Gently pinch the skin under your eyes and give it a little tug. You’ll feel that it’s a little looser and thinner than skin elsewhere. It’s also looser and thinner than it used to be. As we age, some of the fat under the skin of the face disappears. The fat under the skin beneath our eyes that we’re born with is like wind filling a sail. As the fat disappears, the skin under the eyes becomes like a sail without wind to fill it out. In addition, gravity when we’re sitting or standing (which is true most of the day and evening) tends to pull what’s left of the fat downward into the upper cheeks.
Thinner and looser skin also allows fluid to collect, causing a puffy appearance. What was a smooth, pink surface when there was fat beneath the skin now becomes a pale and bloated surface. The dark circles under the eyes are caused by blood pooling in the veins just under the skin. When there was more fat under the skin, it covered up the blood in the veins beneath it.
You’ve probably noticed the puffiness and dark circles when you first get up in the morning. That’s because when you are lying down, gravity is not pulling fluid in your tissues and blood in your veins downward into the cheeks below your eyes.
There’s some folk and spa wisdom about how to get rid of bags, puffiness and dark circles: wet, cool tea bags; cotton balls dipped in rose water; and, of course, the iconic cucumber slices. Many of my patients find that under-eye creams and ointments help reduce the puffiness on awakening.
Finally, there’s always cosmetic surgery if these treatments are not helping you enough — and if you have the means to pay for it.
In some cases there may be an underlying cause you can treat. Nasal congestion is an example, as it causes veins around the eyes to dilate. Treating the cause of the congestion (an allergy, perhaps) can make the dark circles go away.
If your eyes have gotten noticeably puffier and the puffiness doesn’t go away, see a doctor. Puffy eyes can be a sign that you’re retaining fluid, which can be a symptom of a serious medical condition. Also talk to your doctor if your eyes got puffy after you started a new medication or facial cosmetic, or ate a new food. You may be having an allergic reaction.