Causes, Prevention, and Treatment
P uffy lower eyelids or bags under eyes are a common cosmetic problem that appears with aging due to the weakness of the muscles and tissues surrounding the eyes and supporting the eyelids. The bags result from the movement of the normal fat supporting the eyes into the lower eyelids, making them puffy.
The rest of the swelling can be filled with fluids too.
It is usually an aesthetic problem that can is usually solved with over-the-counter products and home remedies. However, some conditions may persist and require advanced treatment and even surgical intervention.
Figure 1 – Puffy lower eyelid; not to be confused with nasojugal lines, nasojugal fat pads or eyelid ptosis. This flaw is only made more noticeable in those with contour depressions and hollow periocular (eye) regions.
Why Do Puffy Lower Eyelids Affect Facial Aesthetic?
Nearly all people have puffy lower eyelids at some points throughout their lives. They make us look exhausted, older, and unattractive, especially if they are accompanied by dark circles under eyes and wrinkles.
Most puffy lower eyelids conditions are mild to moderate causing just cosmetic annoyance. However, if the swelling became severe, it could interfere with your ability to see properly and you should see a doctor immediately. (1)
What Causes Puffy Lower Eyelids?
Most puffy lower eyelids causes are not serious. However, they can be an indicator of a minor or major underlying medical condition.
Allergies can lead to fluid build-up in the sinuses and around the eyes leading to bags under eyes. This puffiness is usually associated with red, watery, itchy eyes. Makeup and skincare products are usually behind allergic reactions causing puffy lower eyelids. (2)
Smoking irritates the eyes, even secondhand and thirdhand smoke can irritate the eyes. Your eyes become watery developing temporary puffy lower eyelids. If you are a heavy smoker, the condition may become permanent. (3)
Poor Sleep & Exhaustion
Not getting enough sleep leads to puffy lower eyelids, red eyes, and dark circles because the muscles surrounding the eyes become weaker and the collagen disappears. Fluids collect under the eyes overnight creating the swelling, which appears obviously in the early morning. People who suffer from insomnia usually have persistent puffy lower eyelids and dark circles. (4)
The skin under the eyes is delicate and any small scratch can lead to under-eye swelling. Hitting this area fills it with blood and fluids causing swelling and bruising under the eyes. (5)
The continuous crying rupture causes ruptures in the blood vessels of the eyelids leading to fluid retention. The blood flow increases to the eyes and eyelids, which accumulates fluids in the lower eyelids causing the swelling. (6)
Increased Salt Intake
Increasing your salt intake (sodium intake) increases water retention in your body including lower eyelids. People who intake too much salt tend to have puffy faces, especially in the morning. The delicate, thin skin around the eyes gets puffy easily, but it resolved spontaneously when you stop eating too much salt. (7)
Conjunctivitis, stye, chalazion, ocular herpes, blepharitis, and periorbital cellulitis are the most common infections causing puffy lower eyelids. The infection can originate from the eyes or the eyelids and can occur in one eye or both eyes. (8, 9, 10, 11)
Underlying Medical Conditions
Certain medical conditions such as Grave’s disease, mononucleosis, and chronic renal failure can be the cause of having persistent puffy lower eyelids that do not respond to home remedies and over-the-counter medications or sudden puffy lower eyelids without apparent reasons. (12, 13, 14)
How To Prevent Puffy Lower Eyelids?
To be able to prevent the best solution for puffy lower eyelids, it is essential to determine the main cause. For example, if puffy eyelids and dark circles run in your family, home remedies may not work, and cosmetic eyelid surgery may be required.
Get Enough Sleep
Having a good night’s sleep will reduce your puffy lower eyelids. Adults should sleep 7 to 9 hours per day. Try to have a good bedtime routine and stick to it.
Determine Your Allergens
Some people have seasonal allergies to certain materials while others are allergic to substances that exist all the time. It is essential to address your allergies and avoid them to avoid rubbing your eyes and prevent puffiness. Eye drops and over-the-counter medications can relieve your symptoms, including puffy eyelids.
Drink More Water
Dehydration can cause puffy lower eyelids. Drinking plenty of water keeps your skin healthy and filtrate your body. Try to drink 8-ounce glasses per day.
Decrease Sodium Intake and Increase Potassium Intake
Most of our foods nowadays contain more salt than before. Try to avoid processed foods and restaurants to lower your sodium intake and to increase your intake of fresh fruits and vegetables.
In addition, try to increase your potassium intake since it enhances your body’s ability to get rid of any extra fluids. Try to add potassium-rich foods to your diets such as bananas, leafy greens, and beans.
Try Eye Creams
Many over-the-counter eye creams can relieve eyelid puffiness, especially lower eyelids, and dark circles. Chamomile, cucumber, caffeine, and arnica are common ingredients because of their anti-inflammatory properties.
Figure 2 – Improved appearance of the lower lid bulging following trans-cutaneous laser blepharoplasty. (a) Before surgery & (b) After surgery.
How To Treat Puffy Lower Eyelids?
It is essential to understand the nature of your aesthetic problems and the best available techniques that can help you to correct them. For example, the best choice for puffy lower eyelids may differ from dark circles and wrinkles.
Transcutaneous lower blepharoplasty rejuvenates the lower eyelid by tightening the excess skin, adjusting muscles, and correcting orbital fat. The operation along with routine lateral canthal support accomplish all the aesthetic demands. (15)
Transconjunctival blepharoplasty depends on improving lower eyelids structures and their cosmetic appearance. The operation should be followed by dermal fillers or injecting autologous fat to correct any side effects. (16)
Hyaluronic Acid Dermal Fillers
Dermal fillers can be used alone or combined with blepharoplasty to rejuvenate lower eyelids. Hyaluronic acid (HA) is the most common dermal filler. If anything went wrong, the effects can be reversed using hyaluronidase. Other fillers such as poly-L-lactic and calcium hydroxyapatite are also used recently. (17)
Laser resurfacing can remove the deepest and most complex lower eyelid wrinkles in addition to correcting puffy lower eyelids. It is usually used for the most persistent lower eyelid problems. CO2 laser resurfacing is usually combined with blepharoplasty for the best results. (18)implants.⁶
Figure 3 – A 60-year-old woman underwent lower blepharoplasty with fat transfer and lateral canthoplasty.(Above) Preoperative right lateral oblique view. (Center) Eight-month postoperative view demonstrating right lateral lid retraction and rounding of the scleral triangle. (Below) Six months after revision, right canthoplasty with correction of lateral retraction and scleral rounding.
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