Under Eye Bags, Acne Scars & Neck Creasing: When Over-the-Counter Treatments Aren’t Cutting It

You’ve purchased countless creams and serums that promised to de-puff your eyes, lighten circles, smooth your neck and décolletage, or erase evidence of acne scars. While these over-the-counter treatments might offer temporary or subtle relief, they haven’t made a lasting dent in your list of cosmetic woes.

Before you spend another dollar on beautifying products, know that their lack of long-term effectiveness is to be expected.

Why Store-Bought Beauty Treatments Are Only Temporary

Our articles frequently mention why beauty products can’t cure skin-deep concerns, but here’s quick recap:

Products that are considered cosmetics by the Food and Drug Administration (FDA) are regulated as Generally Regarded As Safe (GRAS). This means that they can hit store shelves without being subjected to a lengthy evaluation process.

However, cosmetics aren’t allowed to mitigate or treat a disease, or to affect the structure of your body. (If you’d like to learn more about the difference between cosmetics and drugs – even over-the-counter ones – check out this article on GRAS.)

Related: Can Cosmetics Really Penetrate Your Skin?

That’s not to say that some over-the-counter products can’t help. However, if you’re desperate for a lasting solution, it might be time to consider in-office treatments – but, which one?

We asked four doctors (two dermatologists and two plastic surgeons) for advice on the best options to treat the following cosmetic problems: under eye puffiness, dark circles, acne scars, neck creasing, crinkly cleavage, and leg veins. Here’s their advice:

1. Why Are My Under Eyes Puffy?

Before you booking a consultation, be sure to try reducing your salt intake, treating any allergies, and elevating your head during sleep. New Delhi, India-based dermatologist Dr. Sonam Yadav also warns that those who have a medical condition, family history of blood pressure, or diabetes should first see your physician to assess your health and rule out an underlying medical reason.

Assuming other conditions are ruled out, your under eye puffiness is likely caused by a bulge of fat that’s broken off and begun to migrate downwards. 

What’s the Best Way to Treat Under Eye Puffiness?

According to Dr. Anthony Youn, a board-certified plastic surgeon and author of The Age Fix: A Leading Plastic Surgeon Reveals How to Look Ten Years Younger, the only way to permanently reduce it is to remove the fat surgically, with a procedure called transconjunctival blepharoplasty.

The good news? Blepharoplasty is an outpatient procedure, meaning that it doesn’t require an overnight stay. Additionally, Dr. Youn says that the surgery can be completed without any visible scars, and heals within two days.

Eye fat surgery: before and afterImage via Potomac Plastic Surgery

Dr. Houtan Chaboki, MD, a board-certified facial plastic surgeon in Washington D.C., affirms Dr. Youn’s statement, adding that the incisions can even be hidden inside the eyelid for appropriate patients, eliminating any risk of external scars.

Are There Any Alternatives to Surgery for Under Eye Puffiness?

Dr. Youn shares that a potential alternative is on the horizon. “One company is working on a topical cream that supposedly can reduce the puffy fat under the eyes.” The cream is still in FDA trials, but, if approved, could prove a less costly alternative to relieving under eye puffiness.

2. Why Do I Have Dark Circles Under My Eyes? 

First, consider that under eye circles might be a result of an iron deficiency. Up your intake of iron-rich foods, such as spinach – and don't forget to eat a banana to aid with absorption! Unsure if you might be anemic? Your doctor can run a test to cross that concern off the list.

What’s Are the Top Treatments for Under Eye Circles?

If increasing the amount of iron in your diet doesn’t help, Dr. Shainhouse suggests that topical vasoconstrictors might be sufficient to reduce the purple shadows under your eyes. “These agents (which usually contain caffeine) will temporarily shrink the superficial vessels, so that you can’t see them through the overlying skin.”

Dr. Youn adds that dark circles can also be the result of shadowing from puffiness (in which case, see the above remedy), pigmentation in people with darker skin, and thinning skin causing it to become transparent.

“For pigmentation and thinning skin, the best options are lightening creams and retinol creams, respectively,” he says. “Currently, my favorite line for treating these issues is ZO Skin Health.”

If topical treatments aren’t enough, Dr. Chaboki says the next option is to use facial fillers, such as Restylane, around the orbital bone.

Filler injections are performed in-office, but only take about 15 minutes. “Bruising and swelling are minimal,” says Dr. Chaboki, and assures us that patients can wear makeup the same day if desired.” Once injected, your body gradually dissolves the filler. However, results last from several months to a year.

3. What’s Causing Horizontal Creases Across My Neck?

Have you noticed an increase of band-like wrinkles across your neck? According to InStyle, you’re not alone.

Calling the phenomenon “tech neck,” the article says it’s caused by repeatedly looking down at your smartphone, “therefore causing the delicate skin on your neck to wrinkle and show signs of aging more quickly than ever before.” 

Tech neckImage via Anti-Aging Medical and Laser Clinic

How Can I Reduce Horizontal Neck Wrinkles?

According to Dr. Shainhouse, the vertical bands that run from your chin to you collar bone area are due to extra-strong muscles. “They can be reduced by neurotoxin injections,” she says. “However, if the lines are already permanent (aka, static), then you will need treatments to help regenerate collagen, too.”

What if your neck has started to sag, as well as crease? Dr. Youn states that droopy neck skin is best treated by a facelift (surgical) or Ultherapy (non-surgical). Although, he cautions consumers to adjust their expectations for non-surgical options.

“The results from a facelift cannot be matched with any non-surgical treatment, but for those people who don't want surgery, Ultherapy can be considered. It's just nowhere near as effective as an actual facelift!”

4. Can Anything Make My Acne Scars Go Away?

Not all acne scars are the same. According to our experts, there are multiple types of depressions, such as ice pick, boxcar, rolling, atrophic, and hypertrophic.

Types of acne scars Image via Acne.org

Because each type scar is different, they call for varied – and sometimes combined – approaches to treatment. But don’t despair! According to Dr. Shainhouse, each can be managed as follows:

  • Purple, flat scars can be treated with topical retinoids and lasers that target red and purple tones.

  • Hypertrophic, keloid (raised), hard scars can be treated with intralesional steroid injections. They can also respond to repeated micro needling or Fraxel laser treatments to break up abnormal collagen bundles--these are performed about 6 weeks apart). She suggests that sometimes anti-mitotic agents (%-Fluorouracil) can be injected or infused into the skin.

  • Atrophic (indented) scars can be treated with micro needling or Fraxel laser treatments to stimulate new collagen growth--multiple treatments are needed and this can take many months to notice an improvement. Small aliquots of hyaluronic fillers can be injected into an atrophic scar to immediately plump them up.

  • Ice pick and boxcar scars are tough to treat, but their appearance can definitely be improved. Subcision involves taking a cutting needle and using it to cut the bands of the scar and separate the top layer of the skin, so that it can bounce back up. Strong acids (trichloroacetic acid) can be dotted into the depressions to coagulate the proteins and destroy the skin along the walls of the scar, so that it can re-heal. This works well when combined with micro needling and/or Fraxel laser treatment.

Dr. Youn notes people with darker skin should ideally avoid lasers and chemical peels, since they could cause hyper- or de-pigmentation. Alternately, radiofrequency treatments (such as Fractora) are more color-blind, and can be effective.

Related: Got Pimples? How to Treat Adult Acne

5. How Can I Cure Crinkly Cleavage?

Cleavage wrinkles are deep, vertical creases caused by hours spent sleeping on one’s side, where gravity forces the top breast to bend farther past the body’s midline than it should. The lines can also be caused by sports and push-up bras, which smush the breasts together and are often worn for hours.

Those wrinkles might have disappeared by mid-morning several years ago, but as we age – and collagen decreases – cleavage wrinkles can persist well into the evening, eventually becoming permanent.

Unfortunately, there is not a good place to hide the scar from a “chest lift,” so doctors are left attempting to plump the skin.

Dr. Shainhouse suggests that Fraxel laser or microneedling with PRP is your best bet to smooth the décolletage and top of the breasts. “They help encourage new collagen growth, and, when used in more superficial settings, can help break up pigment damage from sun damage.”

See Also: Is Facial Microneedling at Home Safe and Effective? Here’s What Experts Have to Say

6. What’s the Best Way to Treat Visible Veins?

Both Dr. Youn and Dr. Shainhouse advised that not all visible veins are the same – with different types requiring different approaches to treatment.

According to our experts, purple spider veins (the small, squiggly ones that are typically flat) respond best to electrocautery or local injections with hypertonic saline or sodium sotradecol.

Not to be confused with fine, blue veins that can be treated with injections of sclerosing agents, but also respond well to foams.

Finally, large, blue vessels (often called varicose veins), which can be puffy and sometimes painful, are best managed by a vascular surgeon or dermatologist who specializes in treating leg veins. Dr. Shainhouse suggests that treatment is prefaced with a Doppler ultrasound to ensure that it is safe to remove the vessels. Then, the vessels can be treated with injections of sclerosing agents, stripped, or ablated with endoscopic lasers.

Should You See a Dermatologist or a Plastic Surgeon?

Which office to call depends on what cosmetic concern you’d like to treat. Dr. Shainhouse clarifies that the role of a dermatologist is to diagnose and treat skin conditions.

“Board-certified dermatologists are the doctors that are certified to perform cosmetic skin procedures. These include Botox, fillers, lasers, sclerotherapy.”

“Some dermatologists have done an extra year of laser or cosmetic fellowships (that could also include liposuction and eyelid surgery), which is beyond their dermatology residency (4-5 years post-medical school, depending on the country).”

Dr. Shainhouse also cautions that, while all dermatologists are skin surgeons, most dermatologists are not trained to perform liposuction and eyelid surgeries, although some have undergone extra training to offer these treatments.

For invasive procedures, such as facelifts, neck lifts, eyelid surgery, breast surgery, liposuction and other surgeries, she suggests that you seek a board-certified plastic surgeon, as they’re trained to perform body-enhancing surgeries.

Knowing Who Not to See Is Important When Searching for a Specialist

Dr. Youn and Dr. Shainhouse were both emphatic in their statement to steer clear of anyone calling themselves a “cosmetic surgeon.” According to Dr. Youn:

“The term cosmetic surgeon is a catch-all term that can denote any doctor that performs cosmetic procedures, whether properly trained or not. Cosmetic surgeons can, unfortunately, be gynecologists who perform breast augmentation, ophthalmologists who perform tummy tucks, and ER docs who perform facelifts.”

Dr. Shainhouse agreed, adding “The term ‘cosmetic surgeon’ doesn’t really mean anything, except that they advertise themselves as surgeons who perform cosmetic procedures.”

Bottom Line? Don’t Accept Anything Less Than a Board-Certified Specialist

If you are interested in cosmetic injections or laser treatments, make sure to see a board-certified dermatologist or plastic surgeon.

If you are considering actual plastic surgery, then see a board-certified plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery, which Dr. Youn states is the cream of the crop of cosmetic plastic surgeons.

His last words of advice? When it comes to cosmetic treatments, “don't accept any substitutes!”

More on Skincare:


Dr. Houtan Chaboki
Houtan Chaboki, MD, is a board-certified facial plastic surgeon at Potomac Plastic Surgery, in Washington D.C., and a member of the American Academy of Facial Plastic and Reconstructive Surgery.

Dr. Tsippora Shainhouse
Tsippora Shainhouse MD, FAAD, is a board-certified dermatologist at the Rapaport Dermatology of Beverly Hills, and clinical instructor at the University of Southern California.

Dr. Sonam Yadav
Dr. Sonam Yadav (MBBS, Masters in Dermatology) specializes in non-surgical aesthetic procedures. Her practice is located at Defence Colony, New Delhi, IN. Learn more about her experience and practice by visiting www.drsonamyadav.com.

Dr. Anthony Youn
Dr. Anthony Youn is a board-certified plastic surgeon and author of The Age Fix: A Leading Plastic Surgeon Reveals How to Look Ten Years Younger. Learn more about his practice by visiting www.dryoun.com.

Autumn Yates

Autumn draws from a reporting background and years of experience working remotely, while living abroad, to focus on topics in travel, beauty, and online safety.

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