Swelling under the eyes and cheeks
types and causes

Not every swelling under the eye is an “eye bag”. The types of swelling of the lower eyelid and cheek, how to recognise them and how they are treated.

Swelling under the eyes is often explained with a single word — “bags”. In reality, behind it are different conditions that are treated in different ways. The most important step is to find out which one is yours.

1. Transient swelling

It appears in the morning and settles during the day. Causes: salt and alcohol the evening before, lack of sleep, allergies, hormonal changes, crying. It does not need an operation. What helps is enough sleep, a raised head on the pillow, less salt and alcohol, and treatment of the allergy.

2. Fat bags of the lower eyelid

A permanent bulge that does not change during the day. The cause is fatty tissue that has moved forward. It does not go away with creams, massage or a regime. It is treated surgically — lower blepharoplasty.

3. Cheek bags (malar mounds, festoons)

This is a separate problem. The bag lies lower — on the cheekbone itself — and is separated from the eyelid bag by a groove. It is often soft, with more fluid in the morning, and may be on both sides.

• The causes are chronic fluid retention due to impaired lymphatic drainage, sun damage, loosening of the retaining ligaments and descent of the cheek tissues.
• They are hard to treat. Lower blepharoplasty alone often does not correct them, because it corrects the eyelid, while the problem is in the cheek.
• In a suitable case a malar lift or direct excision of the bag is used; the choice is individual and has its compromises (a scar, the possibility of recurrence).

4. Swelling linked to a disease

Swelling of the eyelids and around the eyes can be a sign of a problem with the thyroid gland, the kidneys or the heart, or of an allergic reaction. Warning features are a sudden onset, swelling on both sides, accompanied by fatigue, a change in weight, breathlessness or swollen legs. In that case a GP or endocrinologist is needed first, not a cosmetic procedure.

5. Swelling after filler in the periorbital area

Hyaluronic acid attracts water, and in the thin area under the eyes, which is vulnerable to lymphatic congestion, it can hold on to swelling. That is why, in Dr. Tachev’s practice, filler is not recommended in the periorbital area. If such a filler has already been placed and is causing swelling, the hyaluronic acid can be broken down with hyaluronidase.

How the right treatment is reached

• First — an examination and history: since when, whether it changes during the day, whether there are other symptoms.
• If a systemic cause is suspected — tests and a consultation with the relevant specialist.
• If the cause is local — the choice is between observation, lifestyle measures, blepharoplasty, a malar lift, or a combination.

What cannot be promised

Cheek bags are among the most stubborn changes around the eyes. Improvement is possible, but complete disappearance and the absence of recurrence cannot be guaranteed.

When it is urgent

Sudden swelling on one side with pain, redness, fever or a change in vision needs to be examined immediately.