"Puffy" eyes can give faces a sleepy or unhappy appearance, and no matter how much cover-up you apply, those extra wrinkles and saggy areas can still weigh down your whole look. To discover the best ways to handle this very common and tricky problem, we met with Dr. Paul Stallman, a facial plastic surgeon with years of experience in both surgical and nonsurgical facial procedures.
Younger.com: First of all, what's the real cause behind "puffy" eyes?
Dr. Stallman: Long-term sagginess (ptosis) or puffiness of the eyelid usually happens because the skin gets looser and thinner over time -- this is very common with age -- or because the small fatty deposits just below the surface of the eyelid get larger.
There's also a genetic component: sometimes a patient has naturally lowered brows that make the eyelid skin looser than normal, or those fatty deposits can be larger because of ethnic characteristics. Often it's a combination of all of those factors.
Younger.com: What approaches do you most often recommend?
Dr. Stallman: There's some variation in exactly how I will perform the procedure, but the basic options in eyelid surgery (blepharoplasty) are:
1. Skin tightening. I can remove a very small area of tissue from within the lid crease (for the upper lid) or along the lash line (for the lower lid), so that afterward the remaining skin is tighter and smoother.
2. Fat removal. This is the main approach for lower-lid puffiness that is related to enlarged fatty deposits, and the fat is removed through an extremely small incision on the inside of the lid. I use a laser for this procedure (not all surgeons do), mainly because it cauterizes or seals off the blood vessels, so healing happens very quickly.
3. Nonsurgical treatments. Occasionally I'll see a patient who is younger or has particularly healthy skin, or for whatever reason is not a good candidate for normal eyelid surgery, and in that situation I might recommend a nonsurgical eyelid treatment instead, but those only work in very specific cases.
Younger.com: Lately we've been seeing a lot more over-the-counter products that aim to correct this problem – do any of these really work?
Dr. Stallman: The creams don't make much of a difference unless the puffiness is just the temporary kind that is caused by high intake of alcohol or salt -- that "day after the party" effect -- and in that case the problem will disappear on its own with or without the creams anyway.
Topical solutions have very little effect mainly because they do not penetrate deeply enough to reduce the fatty deposits or tighten the skin. Sometimes you do see a bit of "smoothing" right away because when you rub the area, the tissues swell somewhat, but that effect disappears pretty fast. Surgery obviously doesn't have those kinds of limitations.
Dr. Paul Stallman (http://www.stallmancosmeticsurgery.com) is a Pismo Beach, California facial plastic surgeon performing procedures like laser skin rejuvenation, and eyelid surgery (blepharoplasty) for patients from Fresno to San Luis Obispo. Dr. Stallman earned his medical doctorate from the State University of New York at Stony Brook, and has received years of advanced training in both eye surgery and oculofacial plastic surgery. He is board-certified in otolaryngology (surgery of the head and neck) and is one of only a few hundred doctors in the United States to earn a fellowship in the American Society of Ophthalmic Plastic and Reconstructive Surgery.
Younger.com: First of all, what's the real cause behind "puffy" eyes?
Dr. Stallman: Long-term sagginess (ptosis) or puffiness of the eyelid usually happens because the skin gets looser and thinner over time -- this is very common with age -- or because the small fatty deposits just below the surface of the eyelid get larger.
There's also a genetic component: sometimes a patient has naturally lowered brows that make the eyelid skin looser than normal, or those fatty deposits can be larger because of ethnic characteristics. Often it's a combination of all of those factors.
Younger.com: What approaches do you most often recommend?
Dr. Stallman: There's some variation in exactly how I will perform the procedure, but the basic options in eyelid surgery (blepharoplasty) are:
1. Skin tightening. I can remove a very small area of tissue from within the lid crease (for the upper lid) or along the lash line (for the lower lid), so that afterward the remaining skin is tighter and smoother.
2. Fat removal. This is the main approach for lower-lid puffiness that is related to enlarged fatty deposits, and the fat is removed through an extremely small incision on the inside of the lid. I use a laser for this procedure (not all surgeons do), mainly because it cauterizes or seals off the blood vessels, so healing happens very quickly.
3. Nonsurgical treatments. Occasionally I'll see a patient who is younger or has particularly healthy skin, or for whatever reason is not a good candidate for normal eyelid surgery, and in that situation I might recommend a nonsurgical eyelid treatment instead, but those only work in very specific cases.
Younger.com: Lately we've been seeing a lot more over-the-counter products that aim to correct this problem – do any of these really work?
Dr. Stallman: The creams don't make much of a difference unless the puffiness is just the temporary kind that is caused by high intake of alcohol or salt -- that "day after the party" effect -- and in that case the problem will disappear on its own with or without the creams anyway.
Topical solutions have very little effect mainly because they do not penetrate deeply enough to reduce the fatty deposits or tighten the skin. Sometimes you do see a bit of "smoothing" right away because when you rub the area, the tissues swell somewhat, but that effect disappears pretty fast. Surgery obviously doesn't have those kinds of limitations.
Dr. Paul Stallman (http://www.stallmancosmeticsurgery.com) is a Pismo Beach, California facial plastic surgeon performing procedures like laser skin rejuvenation, and eyelid surgery (blepharoplasty) for patients from Fresno to San Luis Obispo. Dr. Stallman earned his medical doctorate from the State University of New York at Stony Brook, and has received years of advanced training in both eye surgery and oculofacial plastic surgery. He is board-certified in otolaryngology (surgery of the head and neck) and is one of only a few hundred doctors in the United States to earn a fellowship in the American Society of Ophthalmic Plastic and Reconstructive Surgery.
