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Posted on Tue, Nov 8, 2011 : 5 a.m.

Thinning skin can cause under-eye puffiness

By Ask Dr. K

By Anthony L. Komaroff, M.D.


As I get older, I'm noticing unwelcome changes to my appearance. Lately the problem that's bothering me most is bags and puffiness around my eyes. What's causing this, and what can I do about it?


It's said that old age isn't for sissies, and it's true: Of the many age-related changes we go through, changes to the face can be the hardest to accept. I know, because like you, I also look in the mirror every morning.

As we get older, some of the fat under our skin disappears. That may seem surprising, since we fight body fat in other places. With aging, the elastic tissue in our skin weakens and the skin gets thinner. With less fat under the skin beneath our eyes, and with thinner and less elastic skin, gravity tugs the skin beneath the lower lids downward. When this skin droops, it causes bags. Thinner and looser skin also allows fluid to collect, causing a puffy appearance.

Chances are you've noticed this puffiness is worse when you first get up in the morning. If so, you're witnessing the result of how we sleep. Sleeping in a horizontal position allows fluids to collect around the eyes. Veins under the eyes also expand to hold more blood, which can cause dark under-eye circles.

If you were my patient, the red-flag question I would ask you is whether this puffiness goes away as the day wears on. The puffy eyes we get from sleeping poorly, for example, typically get better during the day. If your puffy eyes don't go away, you should see your doctor.

Here's why: Puffy eyes that don't get less puffy as the day goes on can be a sign that you're retaining fluid, which can be a symptom of serious kidney, heart or liver disease. A bad reaction to a new medication can also cause puffy eyes.

According to folk wisdom, placing wet, cool tea bags or cucumber slices on the skin under your eyes will reduce bags, puffiness and dark circles. There's no harm in trying this, but it doesn't work for everybody. The same goes for under-eye creams and ointments. But they are worth a try. There are many more treatments to make the skin of our faces younger than there were 25 years ago. Of course, you can take these too far (which celebrity comes to your mind?). My advice is to try the advice above. If you are otherwise healthy, count your blessings whether the treatments work for you or not.

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Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: