Dear Dr. Seckel, I am 32 years old and have what you call bags and dark circles under my eyes. I have tried Teamine Complex and Retin A but have not seen much improvement. I went to a Plastic Surgeon in Boston who injected Botox and recommended a blepharoplasty but I am not sure I want to go the surgery route. I have read your site and wonder if the ActiveFX can help me. You also mention the Aluma as non-surgical blepharoplasty. Also, you seem to prefer the laser for blepharoplasty. Why is the laser blepharoplasty better? Do you always do the arcus release for dark circles? Is that more dangerous and is the recovery longer? My eyelid bags and dark circles are hereditary and I really don’t want to end up with eyes looking like my mom’s. Please help! Thank you, Sandy, Boston, MA
Dear Sandy,
Many young women your age begin to notice bags and dark circles under the eyes in there 30’s and it is natural to look at your parents and see these changes in more advanced stages. Fortunately, today, with modern eyelid rejuvenation techniques there are many good options to prevent or remove eye bags, puffy eyes, and dark circles under the eyes from getting worse and restoring a youthful appearance to the eyelids.
The eye bags under the eyelids are caused by a combination of skin, muscle, and septal laxity of the lower eyelid and the protrusion or herniation of fat from beneath the eyeball which pushes the lower eyelid outward and thus creates the eyelid bag or puffy eyes.
Years of sun damage and aging and repeated motion of the eyelid also cause skin aging changes in the lower eyelid skin which result in wrinkles and “crepiness” of the skin which also makes the eyelid skin look older.
The dark circles under the eyes are caused by a combination of the above changes and the attachment of the lower eyelid to the bone of the eye socket by a small structure called the Arcus Marginalis. The Arcus Marginalis is a small condensation of tissue which holds the eyelid to the bone and as the eyelid ages the eyelid skin above the arcus marginalis falls down over the tethered skin and creates a shadow or dark circle under the eye. In technical terms this is called the Tear Trough or Crescent Deformity. The Arcus Marginalis is frequently referred to as a ligament but technically it is not.
The various procedures you ask about have very specific applications and when combined can achieve what I call total eyelid rejuvenation. I will try to clarify what each procedure can and cannot achieve. There are many blepharoplasty myths which simply do not hold true, the most notable is that a blepharoplasty alone will remove eyelid wrinkles.
The ActiveFX® laser is an exciting new “lyte” CO2 laser made by Lumenis® which provides an excellent laser skin peel with minimal down time and none of the problems associated with traditional laser resurfacing. I call this the LaserLyte Peel® and it is an excellent surface treatment to remove skin aging changes from the lower eyelid. The treatment takes a few minutes in the office using a topical numbing cream, and the eyelids are red for 2-3 days and pink for 3-4 days and make-up easily covers the pink. I very frequently combine this procedure with a transconjunctival laser blepharoplasty and arcus release.
I also use Botox® injections to lessen the crow’s feet at the corners of the lower eyelids which helps remove wrinkles around the eye.
The Aluma® with FACES is a radiofrequency skin tightening machine also made by Lumenis® which can tighten the lax skin and help improve the appearance of the lower eyelid.
The combination of the ActiveFX® laser skin peel or LaserLyte Peel® and the Aluma® is often referred to as the non-surgical blepharoplasty although this is not accurate as a blepharoplasty addresses the deeper eyelid changes which the two non-surgical procedures do not. The ActiveFX® is usually done once and the Aluma® treatments usually 5-6, are started after a waiting period of six to eight weeks.
In my opinion there are numerous very significant advantages of the laser blepharoplasty over the traditional “cold steel’ blepharoplasty done with a scalpel. In my experience of over 2000 patients there is less bruising and quicker recovery because the laser seals blood vessels as the incision is made thus there is less bleeding. Less bleeding also means a safer procedure because bleeding is potentially the most serious complication of a blepharoplasty. In my hands the laser blepharoplasty is a much quicker operation, time in the operating room is reduced to 1/2 to 1/3 of the time required for a scalpel blepharoplasty and this translates to less recovery time for the patient. I also find that the accuracy of the incision is much more precise with the laser which means a cleaner more precise blepharoplasty.
The Arcus Marginalis Release is a major improvement in the way modern blepharoplasty is done. The release of the tethering effect of the Arcus Marginalis and the grafting of a small amount of fat or repositioning eyelid fat to prevent reattachment frees the skin of the dark circle under the eye and eliminates the dark circle. Side benefits include less need for excessive fat removal which can create a hollow eye appearance and lessens the need for skin removal.
The laser transconjunctival blepharoplasy with arcus marginalis release is the most advanced modern blepharoplasty technique available today. The transconjunctival approach utilizes a small laser incision on the inside of the lower eyelid, the pink part of the inside of the eyelid called the conjunctiva. The benefits of this approach are enormous. Not only is there no visible scar but more importantly the lovely natural shape of the lower eyelid is not changed. The traditional blepharoplasty using an external incision on the outside of the eyelid damages the supporting muscles of the lower eyelid and the eyelid droops after incisional blepharoplasty creating a “sad eyed look” or “hound dog eyes”.
The modern blepharoplasty, the transconjunctival laser blepharoplasty with arcus marginalis release and fat grafting is best called a minimally invasive blepharoplasty and the benefits are enormous. Minimally invasive techniques are particularly important on a structure as delicate and important as the lower eyelid.
I hope I have shed some light on this complex subject which will help sort out the options available to you.
To summarize, lower eyelid skin aging changes can be improved by what some refer to as the “on-surgical blepharoplasty which refers to skin peeling , best done with the ActiveFX®, using a procedure I call the LaserLyte Peel®, and skin tightening treatments using the Aluma®. In addition, Botox® treatments can help reduce the appearance of Crow’s Feet.
The correction of bags and dark circles under the eyes however requires surgery. The modern blepharoplasty, the minimally invasive blepharoplasty, is the laser transconjunctival blepharoplasty with arcus marginalis release and fat grafting. This new modern technique is a major improvement over the traditional scalpel incisional blepharoplasty and avoids the telltale sequelae of the sad eyed look and hound dog eyes.
Thank you for your important question.
For more information on blepharoplasty, plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.
Boston, Massachusetts