Bags under eyes — mild swelling or puffiness under the eyes — are common as you age. With aging, the tissues around your eyes, including some of the muscles supporting your eyelids, weaken. Normal fat that helps support the eyes can then move into the lower eyelids, causing the lids to appear puffy. Fluid also may accumulate in the space below your eyes, adding to the swelling.

Bags under eyes are usually a cosmetic concern and rarely a sign of a serious underlying medical condition. At-home remedies, such as cool compresses, can help improve the appearance of bags under eyes. For persistent or bothersome under-eye puffiness, eyelid surgery may be an option.

Bags under eyes can include:

• Mild swelling
• Saggy or loose skin
• Dark circles

When to see a doctor

You may not like the way they look, but bags under eyes are usually harmless and don't require medical care. See your doctor if the swelling is severe, persistent, painful, itchy or red.

Your doctor will want to rule out other possible causes that can contribute to the swelling, such as thyroid disease, infection or an allergy. He or she may refer you to a doctor who specializes in the eyes (ophthalmologist), plastic surgery or plastic surgery of the eyes (oculoplastic surgeon).

As you age, the tissue structures and muscles supporting your eyelids weaken. The skin may start to sag, and fat that is normally confined to the area around the eye (orbit) can move into the area below your eyes. Also, the space below your eyes can accumulate fluid, making the under-eye area appear puffy or swollen. Several factors cause or worsen this effect, including:

• Fluid retention, especially upon waking or after a salty meal
• Lack of sleep
• Allergies
• Smoking
• Heredity — under-eye bags can run in families

Bags under eyes are usually a cosmetic concern and don't require specific treatment. Home and lifestyle treatments may help reduce or eliminate puffy eyes.

Medical and surgical treatments are available if you're concerned about the appearance of under-eye swelling. Treatment may not be covered by medical insurance if it's done solely to improve your appearance.

Medications

If you think the swelling under your eyes is caused by an allergy, ask your doctor about prescription allergy medications.

Therapies

Various wrinkle treatments are used to improve the appearance of puffiness under the eyes. These include laser resurfacing, chemical peels and fillers, which may improve skin tone, tighten the skin and rejuvenate the look of bags under the eyes.

Eyelid surgery

Depending on what's causing bags under the eyes, eyelid surgery (blepharoplasty) may be a treatment option. During blepharoplasty (BLEF-uh-roe-plas-tee), the surgeon removes excess fat through an incision in the natural crease of the upper eyelid or inside the lower lid. He or she then rejoins the skin with tiny dissolving stitches. The procedure is usually done as an outpatient procedure.

In addition to correcting bags under eyes, blepharoplasty can also repair:

• Baggy or puffy upper eyelids
• Excess skin of the upper eyelid that interferes with your vision
• Droopy lower eyelids, which may cause white to show below the iris — the colored part of the eye
• Excess skin on lower eyelids

Talk with your doctor about the side effects of eyelid surgery — dry eyes, watery eyes, pain, swelling, bruising and blurred vision. Rare complications include visual loss, bleeding, infection, injury to eye muscles, corneal abrasion and drooping of an eyelid.

The following tips can help you reduce or eliminate bags under eyes:

• Use a cool compress. Wet a clean washcloth with cool water. While sitting up, apply the damp washcloth to the skin under and around your eyes for a few minutes using mild pressure.
• Cut down on fluids before bedtime and reduce salt in your diet. This will reduce the fluid retention that can cause bags under eyes.
• Don't smoke. Smoking can aggravate the problem of bags under your eyes.
• Get enough sleep. For most adults, seven to nine hours is a good amount of sleep.
• Sleep with your head slightly raised. It may help to add an extra pillow or prop up the head of your mattress. Or elevate the entire head of the bed a few inches. This helps prevent fluid from accumulating around your eyes as you sleep. Dark circles caused by fluid retention in your lower eyelids usually go away when you get up.
• Reduce allergy symptoms. Avoid allergens when possible. Try over-the-counter allergy medications. Talk to your doctor about prevention strategies if you develop under-eye reactions due to hair dyes, soaps, cosmetics or other allergens.
• Use cosmetics. If you wish to mask your under-eye circles, try using makeup.

Preparing a list of questions will help you make the most of your time with your doctor. For bags under eyes, some basic questions to ask your doctor include:

• What's likely causing my symptoms?
• Is my condition likely temporary or chronic?
• What treatment approach do you recommend, if any?
• What will the treatments cost? Does medical insurance cover these costs?
• What results can I expect?
• Can I do anything at home to improve my symptoms?
• What kind of follow-up, if any, should I expect?

Don't hesitate to ask other questions that occur to you.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you first notice the puffiness under your eyes?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?