Dear Dr. Seckel,What causes dark circles under the eyes? I have dark circles under my eyes and people say I look tired. Thanks, Betty, Columbus, Ohio
Dear Betty,
Dark circles under the eyes are caused by a shadow. The shadow is created by the puffiness of the eyelid skin often called an eye bag or puffy eyes above the dark circle. The eye bag or puffy eyelid skin overhanging the dark circle under the eyelid blocks light shining on the face and creates a shadow, which creates the dark circles under the eyes.The combination of eye bags and dark circles under the eyes are the most frequent complaint I hear from patients seeking eyelid rejuvenation. Remarkable results are possible with laser Arcus Marginalis Release.
The eyeball is surrounded by fat that acts to protect the eyeball from trauma. As we age, the skin and muscle of the lower eyelid becomes loose or lax and begins to sag downward on the face. The fat surrounding the eyeball is normally held in by the eyelid and muscle, but as they become lax the fat pushes outward and begins to create a bulge on the lower eyelid called the eye bag or puffy eye lid. The combination of the eye bag or puffy eye look combined with the dark circles under the eyes often creates what people refer to as the tired look.
The reason a dark circle is created under the eyelid is that the muscle and tissue beneath the dark circle under the eye is attached to the bone of the eye socket and cannot move downward as the eyelid becomes lax and the fat pushes the eyelid forward and down. This tethering of the dark circle under the eye to the bone of the eye socket creates a deep crease called the naso-jugal fold which is the medical term for a dark circle under the eye.
There are several good plastic surgical operations to correct dark circles under the eyes. I use a technique called a transconjunctival laser blepharoplasty, because the laser causes less bleeding than a scalpel so there is less bruising and the patient recovers much quicker. The transconjunctival approach describes an incision which is made with the laser on the inside of the lower eyelid, thus no visible scar is created and there is no change in the shape of the lower eyelid following surgery.
Another very important part of the correction of dark circles under the eyes is called an arcus marginalis release. The arcus marginalis is the tissue that tethers the eyelid to the bone socket holding the eyeball and creates the dark circle under the eye. After removing some of the protruding fat the arcus marginalis which is attached to the eye socket and causing the dark circle under the eye is detached from the bone so it is released from the bone and no longer tethered to the bone and thus the dark circle under the eye is released ande can move with the rest of the eyelid, and the shadow creating the dark circle under the eye is removed.
I then reposition or graft fat onto the bone which lies beneath the dark circle under the eye to plump the depression and prevent the dark circle from recurring.
The arcus marginalis release is a fairly new procedure so you need to ask your plastic surgeon if he is experienced with this technique. I also recommend finding a plastic surgeon who is comfortable and experienced with the transconjunctival laser blepharoplasty.
For further information on dark circles under the eyes or other facial and eyelid rejuvenation techniques visit my Boston Plastic Surgery Practice, read Save Your Face or contact me.
Sincerely,
Boston, Massachusetts
Peabody, Massachusetts