We receive many questions from patients about their under eye concerns. While there are various factors that can impact the appearance of your undereyes such as sun exposure, delicate skin, the natural aging process, sleep deprivation, fluid retention and more, there are now several treatment options available. Whether you are looking to address dark circles, puffiness, or hollowness beneath your eyes, Dr. Kenneth Howe, a board-certified dermatologist at UnionDerm, is an expert in treating this sensitive area of the face.
Dr. Howe graduated magna cum laude from the University of Pennsylvania and then received a medical degree with honors from UCLA; he also completed his dermatology training at the University of Pennsylvania. He is a member of both the American Academy of Dermatology and the American Society of Dermatologic Surgery.
As a cosmetic dermatologist, Dr. Howe is known for his light touch. He believes that smaller, earlier interventions allow patients to maintain a youthful appearance while at the same time preventing or slowing further aging. Dr. Howe is an expert in guiding patients through the variety of treatment options available for the under eye area, and maintains an open dialogue between doctor and patient throughout this process.
We collected questions regarding under-eye treatments offered at UnionDerm for Dr. Howe to answer. Please read below for his insightful and informed answers.
Which under-eye problems and concerns do you treat at UnionDerm?
Many people talk about “circles under the eyes” or “pesky under eye bags” as if they are all the same thing, but several distinct changes affect this highly significant cosmetic area. Many different conditions can affect the under-eye area, such as visible pouches caused by lax, weakened skin; violet to dark purple discoloration due to blood vessels present too close to the surface; excess brownish pigment laid down within the skin; and hollowing from loss or redistribution of subcutaneous fat.
At UnionDerm, we treat all of these concerns using cutting-edge, proven technologies and techniques. These may include dermal fillers or laser treatments such as Vbeam, Excel V, or PicoWay, high-intensity focused ultrasound, radiofrequency microneedling, and more.
How do I know which under-eye treatment is right for me?
Every cosmetic treatment should start with a careful assessment of the patient, and nowhere is this more important than the under-eye area. The complexity of the anatomy and the fact that several different changes might be present, either individually or in combination, make careful examination crucial. Only after we have determined what issues are present can we design a treatment plan to correct them.
I always have a patient look in the mirror while we’re doing the exam because it can be beneficial for them to see the separate changes that together create the appearance of their under-eye circles. Their input can be crucial in deciding which issues to prioritize, that then dictates not only what treatments we do, but the order in which we do them.
Why do some people have under-eye circles while others have under-eye puffiness? And what are the best ways to treat under eye bags and dark circles?
People often mean different things when they say “under-eye circles,” but usually they are talking about discoloration or darkening. If the color is red or violet/purple, they have blood vessels close to the surface, and treatment for these under-eye circles is with a laser such as Vbeam, Excel V, or DermaV. If the color is tan-to-brown, the skin has excessive pigment, which we treat with the PicoWay laser. Sometimes—and this is when close examination is especially crucial—the darkness in the area is not due to any discoloration in the skin, but the result of hollowing that causes the area to appear shadowed. Then, the solution is filler injections.
When people say they have “under-eye puffiness,” they usually mean the skin beneath their eyes has become loose and pouchy. These are also called “eye bags”. Puffy eyes or bags under your eyes might be worse in the morning and improve somewhat over the course of the day or become especially noticeable after a salt-heavy meal. This is because retained fluid shows more readily in weakened eyelid skin.
The best treatments for under-eye pouches are energy-based tightening devices. These differ in the type of energy they deliver to the skin. High-intensity focused ultrasound, radiofrequency, and radiofrequency microneedling are the most common devices used.
In some cases, though, puffiness or pouchiness is more than a matter of loose skin. There can be weakening and failure of deeper structures, and changes of this nature are usually best addressed by surgery such as eyelid surgery. This is a determination that can be made during the initial consultation.
What causes redness under the eyes, and is there a treatment for this condition?
Redness—or a violet or even purplish discoloration—is caused by blood vessels under the skin. We all have blood vessels in this location, but they can become more visible for several reasons. The vessels might lie closer to the surface due to one’s inherited anatomy; the overlying skin may have thinned due to sun damage or age; the existing blood vessels may be abnormally engorged or swollen.
In each of these scenarios, the discoloration can be treated with a laser. The laser light is preferentially absorbed by blood flowing in the vessels, resulting in heat that effectively cauterizes the vessels from within. In addition to being effective, these treatments are safe for all skin types and relatively painless.
What treatments do you recommend for skin laxity or loose skin around and under the eyes? Who is a good candidate?
This is an area where treatments have improved a lot in recent years. At UnionDerm, we have several good options for lax under-eye skin, but my go-to device is Secret RF, a fractional radiofrequency microneedling device. Secret RF delivers controlled and precise electrical energy that stimulates existing collagen fibers to tighten and contract while also promoting the production of new fibers. The result is stronger, more resilient skin that is better able to hold its youthful shape.
I often treat lax under-eye skin with platelet-rich plasma (PRP) injections as well. PRP contains abundant growth factors which naturally stimulate collagen production and revitalization in the skin. PRP injections can be done alone, but I use them more commonly in combination with a stimulatory device such as radiofrequency microneedling.
Are there under-eye treatments that can be combined to provide more comprehensive results?
Absolutely! I do combinations of all these treatments—it just depends on what concerns need to be treated. We might tighten lax skin with Secret RF while clearing away brownish pigment with the PicoWay. Or, lighten red/purple circles with a series of Vbeam treatments, followed by filler injections to address hollowing.
How long do results from under-eye treatments typically last, and what is the maintenance process like?
The duration of results varies a lot from patient to patient, and from one condition to another. However, because the underlying processes causing these changes will continue to occur, maintenance treatments are usually necessary. How soon we do that depends on the treatment. It isn’t easy to generalize, but fillers in this area are typically repeated every 4 to 6 months, lasers 6-12 months, and tightening devices after a year or more.
Schedule a Consultation
If you are bothered by the appearance of your undereyes and have not seen results with eye creams or other over-the-counter solutions, schedule a consultation with Dr. Howe at our Union Square or Central Park offices in Manhattan. During your consultation, you will have the opportunity to ask any questions you may have, as well as discuss your aesthetic goals and desires regarding treating the under-eye area.