How to Get Rid of Tired Puffy Eyes, What Causes Wrinkles Prematurely, & Their Treatment

A 22-year-old woman says she always looks tired and gets severe lines when she smiles. Her eye bags are always puffy and look like she didn’t sleep well. She wonders if Botox® could make the bags even more prominent.

Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that puffy bags are mostly due to lower eyelid fat prolapse. In many cases it increases with aging, but it in this woman’s case it is more of a genetic trait. He has had patients as young as 14-years-old who had tremendous bags and he has done surgery to help them.

If a person’s bags are constant and persistent, then a definitive surgical procedure is the solution to the issue. Unfortunately, a lot of people try to camouflage bags that are beyond a certain threshold with fillers and they get themselves in all kinds of problems.

In Dr. Prasad’s practice, he is very hesitant to start people in their early 20s with Botox®, Dysport or any other neurotoxins because he wants to first look at what is causing the lines. There are two significant causes that accelerate aging which are sun exposure and smoking. If they are spending a lot of time in the sun or using tanning beds, it is highly likely that they are photoaging their skin and causing a big impact on the quality of the skin. Aging causes skin to lose collagen and blood supply until the quality diminishes and it becomes thinner. On the other hand, smoking generates carbon monoxide which literally chokes the oxygen away from the skin and generates free radicals that damage the skin. Besides doing horrible things to the lungs or to the blood vessels, its damaging effects are reflected in the skin. Dr. Prasad can literally look at a person and know that they are a smoker because of the quality of their skin as there’s almost a graying quality. If they are smoking or spending a lot of time in the sun, it is recommended that they diminish the amount of sun exposure. They should wear sun block and stop smoking altogether.

Dr. Prasad further explains that 10 units of Botox® which is going to be divided into both eyes is not likely to make the bags look worse because it’s not a really high dose. It is something that she might want to consider trying if she doesn’t have any of the other risk factors he described. However, Botox® reduces the activity of the muscle called the orbicularis oculi muscle. This is the muscle that works when someone squints their eyes. Dr. Prasad always educates his patients to differentiate and to distinguish between the activity of the muscle and the lines that are formed when they smile. When smiling, the cheek moves up and it is almost mistakenly thought of the activity of the muscle. People would mostly come back for Botox® enhancement. When he shows them the difference, then they understand that physical movement cannot be changed with Botox®. They wouldn’t want to stop their cheek from moving up.

Dr. Prasad says that she must get additional opinions and certainly explore the risk factors that might be accelerating the aging of her skin. She should meet with more than one doctor and get some additional opinions to help her understand the situation with her eyes.

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