Dear Dr. Seckel, I am 56 years old and have terrible dark circles under my eyes. I also have puffiness and eyelid bags. My skin is pretty good; I don’t have a lot of wrinkles. A friend told me that I could have implants placed to correct the dark circles. Is this true? I have heard of breast implants, but are there really implants for dark circles? Do they work? Thank you, Denise, San Francisco, CA.
Dear Denise,
Believe it or not there are tear trough implants made to correct dark circles under the eyes and for eyelid rejuvenation which are also called the tear trough deformity. They are very different from breast implants so don’t confuse the two. Breast implants are soft and contain a liquid such as saline or silicone. The implants used for dark circles under the eyes are soft also, but are made of solid rubber and contain no liquid.
To understand why an implant would be used to correct dark circles under the eyes or the tear trough deformity you need to understand what causes the dark circles in the first place. Please check the archives of Ask Dr Seckel for further information about dark circles under the eyes.
Briefly, dark circles under the eyes are caused by the fact that the skin and muscle of the eyelid dark circle are firmly attached to the underlying bone of the eye socket while the tissue above and below the dark circle is not. Thus the eyelid skin above the dark circle and the cheek skin below the dark circle are allowed to sag as the skin ages. In addition, as we age, the fat beneath the eyelid skin also sags and pushes out on the lower eyelid creating the eyelid bag. When this happens the eye bag hangs over the dark circle and makes a shadow, which makes the dark circle even darker and more noticeable and creates the tired look. If a person has “hollow eyes” to begin with, the dark circle can increase the appearance of hollowness of the eyes.
Eyelid rejuvenation procedures designed to correct dark circles under the eyes a plastic surgery operation called the blepharoplasty or eyelid tuck is required. However, when dark circles are a problem a special modification of the blepharoplasty operation needs to be done.
A blepharoplasty with an arcus marginalis release is required to remove dark circles under the eye. The arcus marginalis is a small attachment that holds the dark circle attached to the bone, and this attachment must be released so that the dark circle is no longer attached to the bone. I do this operation through the inside or pink part of the eyelid with a laser through a transconjunctival incision to avoid a scar on the outer eyelid skin. This is called a laser transconjunctival blepharoplasty.
In addition, since the dark circle is thinner than the cheek below and the eyelid above, the dark circle must be “plumped up” in some way. This can be done with fat removed from the eyelid fat pocket, or a small soft rubber tear trough implant can be placed on top of the bone where the dark circle was attached, to prevent the dark circle from attaching again, and to plump up the dark circle and make it less noticeable. Some surgeons inject fat in the dark circles instead of doing the surgery, but I prefer the surgical technique I described above.
Recently some doctors are injecting fillers like Restylane® or Hylaform® into the eyelid dark circle to plump the dark circles under the eyelids but I worry about any injection around the eye for fear of injuring the eye. I do not recommend soft tissue filler injections at this time.
So, to answer your question, your friend is correct, there are implants available to correct dark circles under the eyes. Eyelid surgery is very complex and it is very important that you consult a board certified surgeon who is very experienced in eyelid surgery.
For further information visit my Boston Plastic Surgery Practice read Save Your Face or contact me.
Good luck.
Boston, Massachusetts
Peabody, Massachusetts