Yes, fat transfer can be effective in some. I prefer to use dermal fillers over nanofat. Why? Because fillers achieve predictable results with more finesse in this area. I do employ fat transfer for larger volume deficits such as atrophic scars.

Dark circles are often associated with prominent eye bags. Often there are many contributing factors including contact dermatitis, atopic dermatitis, constitutional pigmentation, anatomical tear troughs, prominent muscles of the orbit & volume loss of the mid-medial cheek.

The treatment algorithm for managing dark circles is extremely complex. A targeted approach is best, depending on the underlying pathology. I employ pico, nano & fractional lasers, dermal fillers, neurotoxin, topicals & energy devices according to the pathology.

Some cases of eye bags are due to overactive muscles under the eye (hypertrophic or hyperactive orbicularis oculi). This is more commonly seen in patients who squint. Simple muscle relaxing injections can help. Treatments are easy, affordable and often last 3-6 months.

Lasers can help improve eye bags by reducing skin laxity. In some cases, loose skin & resultant eye bags are secondary to collagen loss. Lasers can help rejuvenate & replenish loss collagen. Most cases do well with simple fractional lasers.

Fully ablative laser resurfacing is indicated for patients with marked laxity, sun damage, wrinkles or festoons.

Eyelid skin can be tightened by other methods including HIFU & RF treatments. I prefer Tempsure RF for eye bags over HIFU (which I use occasionally off label for upper eyelid skin).

Eyelid skin can be tightened by other methods including HIFU & RF treatments. I prefer Tempsure RF for eye bags over HIFU (which I use occasionally off label for upper eyelid skin).

Surgical procedures may be indicated for some cases of under eye bags. This procedure is called a blepharoplasty or eyelid surgery.

For under eye bags this is best performed by an eye surgeon as they make the incision in the lower eyelid (transconjunctival approach). Often a small amount of fat is removed. In some cases they can repurpose fat in other areas of the orbit.

I do perform upper eyelid surgery as the approach is from the skin, however I do believe that lower lid surgery is best approached from the conjunctiva as the risk of ectropion is lower.

An allergist is the doctor of choice if your eye bag skin is itchy, scaly, or sore. The correct treatment is not a skin directed procedure, but is a medical approach.

In most cases investigations such as RAST testing, & patch testing may be required. Common allergens include fragrance, nickel, metals, preservatives, & dye. This is performed by a medical dermatologist with a special interest in patch testing.

Creams have a marginal effect on eyebags. They are useful to treat eye bags secondary to skin irritation. Simple white soft paraffin can be helpful if your skin is inflamed. Other ingredients to consider include-

• Caffeine: can modulate blood flow & reduce congestion.
• Vitamin K: can reduce the appearance of eye bags.
• Hyaluronic acid: can provide dermal support & moisture.
• Peptides: can help build up collagen
• Argan: is anti-inflammatory & anti-aging.
• Retinol: can increase collagen & elastin.
• Arbutin: can reduce dark circles.
• Citric acid: is a gentle AHA used around the eyes.
• Ascorbic Acid: can provide brighter skin, reducing dark circles.
• Licorice extracts: can reduce pigmentation around the eyes.

High-end eye creams include TNS Eye Cream by Allergan, whilst Swisse produces an affordable product with Vitamin K, Caffeine & argan oil. I suggest you save your dollars & try the Swisse product.

Here are some DIY helpful hints to reduce eyebags. Try this before seeing me!

• Cut out all skincare products that may contribute to skin irritation. Commence on liquid paraffin eye ointment nightly.
• Use cool compresses, a clean towelette is more convenient than keeping cucumber slices.
• Reduce salt intake, reduce the amount of fluid intake before bedtime.
• Don’t smoke, poor circulation is one of the contributing factors for eyebags.
• Get enough sleep, try to sleep with your head slightly elevated.
• Reduce allergy symptoms that may cause you to rub your eyes. Consult your pharmacist for antihistamines. Failing that see an allergy specialist, or medical dermatologist.