Dealing with the tired look of your eyes? Eyes are one of the most attention-grabbing features of the face, and, like it or not, they will undergo unwanted changes over time. There are several unique features of our eyes: the skin around the eyelids is the thinnest in the body, and it becomes thinner with time due to the loss of collagen and connective tissue. Under the thin skin, it is surrounded by a complex muscle system and protects one of the most delicate structures of our body which are the eyes. 

In this article, Dr. Shilpi Bhadani, the founder of SB Aesthetics Clinic, the best plastic surgery clinic in Delhi, India, will be discussing details about the under-eye bags and under eye treatment. Let’s start by learning the basics about eyes.

An Overview of Eyes
Eyes are woven in a mesh of blood vessels, and that is why any procedure around the eyes is prone to a chance of bruising. The muscles of the eyes are constantly at work by blinking and spreading the tear film over the exposed part of the eyes so that it is protected from dryness by the external environment.

Changes Eyes Undergo

• Crow’s Feet- With time, due to the tissue thinning, the muscle fibres' movement starts becoming more visible in the skin, and that shows up as crow's feet on the outer side of the eyelids. 
• Under Eye Hollowness- It is an expression of similar changes going on around the per-orbital area (the area around the eye orbit=eye in medical terminology).
• Droppiness- With age also comes the fat loss of the area that we call the lid-cheek junction and of course, there is the effect of gravity due to which the cheeks sag, pulling eyelids in the lower position. This is the reason why when you uplift the cheeks, the area around the eyes also seems to improve without doing anything directly on it. The drag is neutralized, and hence, the eyelid does not get pulled down there by looking more rejuvenated.
• Eye Bags- It is another major concern that worries many of us as we age, and that is the appearance of eye bags. Now, obviously, this is more common past the Middle Ages, but for some people, due to hereditary factors, this also appears much earlier. This gives rise to much-uninvited attention and comments like "Why do you look so tired?" " Did you have a sleepless night?" " Are you drinking too much alcohol?" 

Effective Treatments to Address Issues Concerning Eyes
We are also aware that dermal fillers are very commonly used nowadays to rejuvenate the face. Filler injections are common in areas like cheeks, lips, chin, under-eyes and a few other areas, too, like sculpting the jawline. As a Plastic Surgeon, it is routine for me to do fillers on a daily basis, says our adept cosmetic surgeon, Dr. Bhadani. Sometimes, I also deal with an unsatisfied patient of another practitioner or with patients who have had fillers in the past and no longer want to continue to do them. They still would like to look better and more rejuvenated than their present self. Let’s first learn about eye concerns. 

Detailed Insights for Eye Concerns
Our eyes are spheres that are well cushioned from the daily jolts and jerks of movement by a thick padding of fat all around them. There are septae, which are curtain-like structures that keep the fat in its place and don't allow it to bulge out. There are also muscles around the eye, which are the blinking muscles, which help do the same. As we age or due to hereditary conditions, the fat may hypertrophy, or the septae may become loose, and the muscles also lose their tone over time. All these factors will cause the fat to bulge out and show as festoons on the lower eyelid.

Once this fat bulges out, there is also the appearance of a groove underneath it, which is due to the fat bag. As soon as we suppress the fat bag with our fingers, we can notice that the under-eye area looks much better. So, that is a clear indication that getting rid of this swelling will make the eyes look fresh. The direct solution to this is a lower blepharoplasty procedure done under the care of a plastic surgeon. What if you are not ready for surgery as yet? Are there solutions that can be offered non-surgically?

Non - Surgical Options for Under Eye Bags Treatment
Currently, a lot of fillers are being put to hide the under eye bags and look fresh. The treatment of this area is not like a blanket therapy and needs to be done with caution because we need to look better after any procedure and not worse.

How Do We Diagnose What We Require? As I mentioned previously in this article, the periorbital area undergoes a lot of change, this change can also be an excess decrease of the cheek fat. If it is so, and the eye bags have been unmasked by volume loss in the surrounding areas, then filling in this area is definitely a good solution and removal of the fat bags may not be required.

• Dermal Fillers: This filling can be done by dermal fillers as well as your own fat, which is a more natural filler. The filling in this area requires nuances and training as it can be potentially unforgiving. 
  
  Filling for under eye hollowness is easier as it is a deficient area we are treating. However, when we are dealing with significant eye bags, we are just trying to hide the under eye bags which are already prominent by adding more volume. This method, although it may look like an easier solution initially, is not the correct way to go about treating significant eye bags. At best it can be better a little, but repeated procedures of filling in this area are fraught with uncertainty and a swollen look.
• Dissolution of the Fillers: There is a condition called malar edema, which is also very frequent in the filler under eye areas and overfilled cheeks. There are lymphatic vessels which drain the body's water circulation around the eyes; these become blocked with overfilling and this gives the look of a swollen area on the outer part of the under eyes. The solution to this problem is undoubtedly the dissolution of the fillers, and if at all rejuvenation is required, then we should go for a surgical alternative to achieve that, or if a repeat filler is desired, then go to a professional like a plastic surgeon who understands the detailed anatomy of the area. 
• Filler for Under Eyes: Good only when we have an actual volume loss. The filler to be done should achieve only under-correction, and the filler chosen also plays an important role as all fillers are not the same. The under eye fillers are less hygroscopic and have less swelling than volume fillers. Natural results are obtained with under-correction during filling. Once the fillers settle down in 2-3 weeks, the area starts appearing more natural. The doctor says I usually do not inject more than 1.5 ml to 2 ml in the under eye area in one go. I am happy to see the patient back in my office in about three weeks to decide if more fillers need to be done. 
  
  Note: The good thing about fillers is that we can undo it with an injection of hyalase (an enzyme that dissolves the Hyaluronic acid). This is an in-office treatment and takes minutes.
• Under Eye Bags Surgery: There are two approaches to do this. One is a no-visible-scar approach and is performed from the inner side of the eyelids; the other is from the skin side and requires a cut under the eyelashes. Scars are not a major concern as if done well; one is hardly able to tell the scars. My preference is to do it from inside the lids. As the recovery is much quicker if, additionally, the skin is loose, then we can treat that with laser or a simple pinch removal of skin rather than doing the entire procedure from the trans-cutaneous route.
  
  Benefits: This is a procedure from which recovery is quick. It requires no stitches at all if done from inside the lids. Additionally we can also augment the cheek area with one's own natural fat via injection. The procedure can be performed very safely under IV sedation with local anaesthesia, and patients can be discharged on the same evening.

What does the Recovery Look Like?

• The bruising may look bad for some patients in the early 2-3 days, as well as the swelling, but all this subsides quite rapidly in about a couple of weeks, and if any bruises are still present, they can be concealed easily with makeup. 
• One is required to avoid the direct sun so that pigmentation is not increased. Healing creams can help in settling the areas really quickly, and many patients are able to join the office or interact socially in 7-10 days without any telltale signs of the surgeries.

Conclusion
All in all, periorbital ageing or tiredness needs to have a clear diagnosis first before concluding the right approach to the problem. If you have gotten fillers done previously and would want out now, lower eyelid blepharoplasty is the procedure you should be looking at. If, however, you would like to go ahead with filler, tread with caution and avoid getting overfilled in this area, as the appearance will not be natural. Subtle treatments are better so that even with non-invasive methods, you can enjoy a rejuvenated look for a long time. 

A Plastic Surgeon is your best bet for understanding the problem and taking a balanced approach so that an informed decision can be taken. To know the best suitable treatment approach for your under eye concern, book an appointment with our best plastic surgeon in Delhi, India, Dr. Shilpi Bhadani, at SB Aesthetics. Start your journey towards getting the eyes that speak volumes!