Lower eyelid bags can make you look older and more tired than you actually are.  These bags and shadows are usually caused by lower eyelid fat pouches that are bulging in combination with hollowing of the upper cheek in an area called the "tear trough". 

There is a surgical option to correct these bags that removes and/or shifts the fat pouch.  The surgery may also involve fat injections and laser resurfacing to smooth the surrounding areas.  Surgery gives the most long-lasting benefit, but it also involves some downtime, usually a week (or a few) of swelling, bruising, and redness.

The non-surgical correction for eye bags involves filler injections to plump the hollow, sunken areas that create shadows under the eyes.  The fillers can last a year or more and have little downtime.  Most people can return to work after the treatment that takes about 15 minutes. 

The patient above (who generously allowed us to use his photos) had Juvederm Ultra placed by Dr. Brett Kotlus in the tear trough and upper cheek.  He was totally thrilled with the result.  Dr. Kotlus is one of the most experienced under-eye filler injectors in the state of Michigan and uses special techniques including blunt microcannula delivery systems to prevent bruising and reconstituted hyaluronic acid to ensure a smoother, more natural contour. He performs these treatments in the Macomb county office at Allure Medical Spa. 

Unwanted scars can be a devastating result of cystic acne, leaving one with a dimpled, irregular skin surface.  Avoiding these scars before they occur is the most desirable course of action, but sometimes it is too late.  Treatments can alleviate the visibility of these irregularities.  The specific treatment options vary and should target the type of scar present.  Sometimes a combination of scar types are seen on an individual. 

A key point is to realize that acne scar treatments do not often eliminate acne scars, they can reduce their visibility.  Reduced shadowing and scar depth is the goal of treatment, but signs of the scars are often still seen.  In certain cases, the skin can look exceptionally smooth after treatment, but this is not true for all patients.  

Above is a diagram of acne scar types.  The deepest, ice-pick scars are the most difficult to treat.  Chemical peels (using the CROSS method with TCA) and laser resurfacing may be of the most benefit in ice-pick scars.  Other techniques for deep scars include skin punches and floating punch grafts.

Box-car and rolling scar types often respond better than ice-pick scars.  These are best treated with laser resurfacing and dermal fillers.  The Fraxel laser has an excellent track record when it comes to acne scarring.  Fraxel Restore uses fractional photothermolysis with an erbium laser to build collagen in the dermis.  Fractional CO2 lasers such as ActiveFX and DeepFX and Fraxel Repair are also excellent for these types of acne scars.  Fillers used to improve acne scars include hyaluronic acid (HA) products (Juvederm, Restylane, Perlane). In Michigan, HA fillers are the most popular form of wrinkle and injectable acne scar treatments, especially when performed in conjunction with laser resurfacing. 

An upper blepharoplasty or eyelid lift is a wonderful procedure that shapes the upper eyelid.  The result will frequently give you a more youthful, less tired appearance, brightening up the entire face.  The cosmetic upper eyelid lift does involve an incision, created with a laser, radiofrequency device, or scalpel.  But the scars almost completely disappear with time.  How does that occur?

The upper eyelid has a natural crease, usually 6-11 millimeters above the eyelashes, following a smooth arc.  The upper eyelid lift scar can be placed so that it coincides with your pre-existing crease.  In the photo below, the dotted red line shows the position of the eyelid crease, and the right side demonstrates an eyelid that already had a blepharoplasty, with a barely detectable scar.  

If you are considering aesthetic blepharoplasty, ask your surgeon if he or she plans to place the scar within the eyelid crease.  There are techniques that facilitate the scar/crease alignment.

Dr. Brett Kotlus is a cosmetic eyelid specialist that offers free consultations in the Detroit Metro area in Michigan. To learn more about cosmetic eyelid procedures, visit his website, EyeliftCenter.com. 

In this video, Dr. Kotlus describes Thermage and Ulthera, two non-surgical facial procedures that firm the face.  Thermage is a radiofrequency device and Ulthera delivers focused ultrasound. Both of these procedures are available at Allure Medical Spa in Michigan.  

Dr. Kotlus discusses the 3 options for nonsurgical fat reduction including Zerona, Liposonix, and Coolsculpting. These are offered at Allure Medical Spa in Michigan and one of the doctors can discuss these with you during a consultation to determine if you are a candidate.

You can read more about these procedures here.