Why Are my Eyes So Puffy? My eyes are always puffy. There are some days,
even more than others. They are always sensitive to the wind to the point where they tear.
I do get enough sleep and there is no change. When I squint my eyes I can see a sac within
the bag and when I push on it, it disappears until I squint again. What’s wrong with my
eyes? I do not want surgery. Thank you for your question! You’ve submitted two photos and each photo
is one is of you at rest and one is of you squinting. And you mentioned in your question
that you’ve had some irritation related to the wind as well as puffiness under your eyes
that is variable that there is some issues with sleep and that when you squint, there
is a bag in the bag. And at the last part of your question, you mentioned you don’t
want surgery. So as an oculofacial cosmetic surgeon, I have
had a tremendous experience with situations like yours. And everyday, people come in with
this awareness and concern and naturally, nobody wants surgery. You know, people don’t
normally come in wanting surgery but people choose to have surgery because non-surgical
alternatives don’t solve their problem. So let’s begin by understanding what your situation
is and break down a little bit. First of all, the bags and the sensation of
your eyes are basically unrelated. The awareness of sensitivity is typically a manifestation
of dry eyes and allergies. So most likely you would benefit from visiting an ophthalmologist
and getting an idea of what’s going on with the health of your eye and not related with
the puffiness around your eyes. Now certainly puffiness around the eye can be further enlarged
from the effect of allergies but there’s no direct association between puffiness and eye
irritation. So let’s look at particularly the photo at
rest. With the photo you submitted, there’s a bulge of swelling which from my perspective
appears to be what we call lower eyelid fat prolapse. Now lower eyelid fat prolapse means
that the fat that’s normally around your eyes pushes forward and herniates. So we call that
herniated fat. Now when people have this type of situation, very often they will good days
and not so good days. In other words, in the beginning, in the early stages, people notice
that that there are days they don’t see it as much and other days, they see it a lot.
Most of the days, people come to us because they’re having more bad days than good days.
And typically, some people will start their own treatment by getting topical creams and
going to some of the drug store chains and other make-up places and beauty and cosmetic
places and they’ll try to get all kinds of under eye creams and unfortunately, none of
them will work because puffiness related to fat prolapse will not respond to creams. Now some people will try to choose to get
some fillers. Fillers in the tear trough area or the rim underneath the eye to try to camouflage
the area. Now that has become really popular than it should be because there’s a simple
threshold beyond which any more filler added to that area can make the eyes more puffy. And as far as the dynamic activity that is
demonstrated when you squint, there’s a second part of the anatomy that you can be aware
of and that is called the orbicularis oculi muscle. Now that is a muscle that can contract.
It’s like when you contract a bicep, the bicep gets bigger. When you contract the orbularis
oculi muscle, it causes a ridge to form and it is a normal action of that muscle. So I think you should ask yourself how much
of that puffiness under your eye bother you. And as much as you don’t want to have surgery,
this may be utterly the right choice for you but I think seeking some professional opinions
is the next appropriate step. And I think first seeing an ophthalmologist to get a hold
in the management of eye irritation is probably the number one thing that you should pursue.
Ask your ophthalmologist about the allergies underneath your eyes. Most likely they’ll
just shrug their shoulder and say “It’s just puffiness.” But at least you’ll know it’s
not directly related to your eye irritation. After that, based on your concern about the
appearance and whether if people are asking you if you’re tired because puffiness under
your eyes is not just an aesthetic issue. There’s so much about nonverbal communication
that people are more aware of when they are continuously manifested is that nonverbal
communication of puffy bags under the eyes is saying to other people you’re tired, you’re
upset, you’re sad. And so that level of frustration or tired of looking tired is the most common
thing that people come to us when they’re ready to have surgery. So seek some qualified experienced cosmetic
surgeons. I’m recommending surgeons as opposed to non-surgeons because non-surgeons will
try to push you to do non-surgical procedures that may end up ineffective or limited to
deliver what you want. And don’t be afraid that a surgeon may try to push you very hard.
Any surgeon that try to push you is maybe someone who is not the right fit for you.
My role as a surgeon is to teach and for patients to make their own decision. But at least the
surgeon has the capability to address the full range of issues. So I hope that was helpful
and thank you for question!