Under-eye bags: how to diminish them?

Certain actives in cosmetics, such as caffeine or vitamin K, could help to reduce under-eye bags. Indeed, caffeine has vasoconstrictive properties that can improve blood flow around the eye contour. By reducing the diameter of the blood capillaries, this active ingredient decreases the amount of blood and lymph that can accumulate under the eyes, which can limit the swollen appearance of bags. Vitamin K appears to have a similar decongesting effect and, according to some studies, could strengthen vascular walls. It would reduce the fragility and permeability of vessels, thus promoting lymphatic drainage and overall microcirculation.

While cosmetic treatments can help to reduce certain types of under-eye bags, they cannot affect those caused by genetics.

The effects of caffeine on the eye contour have been studied through several clinical trials, one of which was conducted with 53 individuals presenting with under-eye bags. Over a period of 12 weeks, these volunteers applied a cream composed of 4% blueberry extract, 5% β-C-xyloside, and 0.2% caffeine twice daily. At the end of the three months, a significant improvement in the appearance of the bags was observed, suggesting the efficacy of caffeine in reducing under-eye bags. However, it would be beneficial for further research to confirm the anti-bag effects of caffeine under the eyes.

Regarding Vitamin K, no direct study has shown that it can alleviate puffiness. However, some work conducted by KAWANA and his team is encouraging. They evaluated the effects of a gel composed of 2% Vitamin K, 0.1% retinol, and 0.1% Vitamins C and E on the bluish dark circles of 57 volunteers. After eight weeks of application twice a day, a decrease in haemostasis, that is, the stagnation of blood under the eyes, was observed in 27 individuals. Even though more research is still needed, these initial results are interesting and could be extrapolated to watery puffiness, sharing a common cause with vascular dark circles: slowed microcirculation.

Tip The cold also has a decongesting effect that can help to reduce under-eye puffiness. Therefore, to maximise the benefits of your skincare products, it may be beneficial to keep them in a cool place.

When cosmetics are no longer sufficient and the discomfort caused by under-eye bags becomes too significant, some individuals turn to aesthetic medicine techniques such as Endolift laser, which utilises a diode laser. During the session, an optical microfibre of 200 to 300 nm is inserted into the dermis before being gradually and controlledly slid, with the aim of heating the dermis and tightening the skin. The laser generates micro-channels in the tissues, allowing them to be tightened but also to stimulate the fibroblasts, the cells responsible for the production of collagen and elastin. Moreover, the applied heat helps to reduce subcutaneous fat deposits, characteristic of adipose bags.

A pilot study involving 9 patients has recently explored Endolift therapy as a means to reduce under-eye bags. The volunteers were monitored for six months following the laser session, and the effects were evaluated by three dermatologists. The biometric results obtained showed an improved elasticity of the skin around the eyes, as well as a significant improvement in the appearance of bags in approximately 90% of patients. Furthermore, no side effects were reported. Therefore, the Endolift laser appears to be emerging as a painless, minimally invasive and interesting method for treating under-eye bags.

Another aesthetic medicine technique for reducing under-eye bags is radiofrequency. Non-invasive, this method uses electromagnetic waves that generate heat in the deep layers of the skin, thereby stimulating the production of collagen and elastin. Radiofrequency is generally considered a gentle alternative to hyaluronic acid injections. It can be performed on various parts of the face, including the delicate area around the eyes to reduce bags. Several sessions may be necessary to achieve satisfactory results.

The effects of radiofrequency in combating signs of skin laxity have been evaluated through several studies. In terms of its effectiveness for eye bags, we can refer to recent work carried out by ROTSZTEJN and his team. 23 patients received five sessions of radiofrequency treatment at weekly intervals. The measurement of the biomechanical properties of the skin showed a 25% increase in the tension of the upper and lower eyelids. Furthermore, of the 6 patients with under-eye bags, 3 of them observed a reduction in the swelling of their lower eyelid. While radiofrequency is primarily known for its effects on wrinkles, it also appears to have an impact on under-eye bags.

Significantly more invasive, blepharoplasty, or eyelid surgery, is a surgical technique that allows for the removal of excess fat found in cases of adipose pouches. Performed at a minimum under local anaesthesia, it sometimes requires an overnight stay at the clinic to prevent the risk of post-operative swelling. The blepharoplasty procedure is as follows: the surgeon makes a small incision in the lower eyelid to access the subcutaneous fat and remove the excess. The wound is then closed with sutures.

Blepharoplasty typically yields very good results. A 2011 review evaluated the satisfaction of 50 patients who underwent this procedure and a satisfaction rate of 96% was measured. However, blepharoplasty can lead to complications. Most commonly, it causes oedema, which usually subsides after a few weeks. Occasionally, blepharoplasty can also cause an infection, tear secretion disorders, an inability to close the upper eyelid, or more or less permanent scars. Fortunately, most of these inconveniences can be corrected by the surgeon in the days following the operation.

Finally, it is possible to conceal small fat pockets under the eyes using hyaluronic acid injections. This is injected just below the bags, which allows to fill the hollow present under the swelling and thus visually reduce the bags under the eyes. Hyaluronic acid injections are performed at the dermis level using a cannula with a round tip. Although rare, side effects are possible, ranging from simple redness, bruising or temporary swelling to tissue necrosis, including bacterial infections. Rapid intervention can limit the risk of long-term sequelae. Finally, it should be noted that, as hyaluronic acid is a biodegradable molecule, the results obtained are temporary and last on average between 6 and 24 months.

A recent study has highlighted the benefits of non-crosslinked hyaluronic acid injections in reducing under-eye bags in 55 young women. These patients were monitored over a year and their satisfaction was evaluated: one declared herself "unsatisfied", 9 considered themselves "satisfied", and 45 were "very satisfied". Furthermore, the progression of under-eye bags was observed throughout the year and the improvement was quantified immediately after the procedure, three months later, and six months later. The results are compiled in the table below.

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• ROTSZTEJN H. & al. Non-ablative radiofrequency treatment for skin in the eye area – clinical and cutometrical analysis. Journal of Cosmetic Dermatology (2016).

• BEHRANGI E. & al. Endolift laser as an effective method for lower eye bag treatment: a case series study. Lasers in Medical Science (2022).

• LUO X. & al. Clinical effectiveness and safety of composite non-cross-linked hyaluronic acid in the treatment of tear trough-lower eyelid bag deformity. Journal of Cosmetic Dermatology (2024).