Dear Dr. Seckel, I am going to have a blepharoplasty done to remove the bags under my eyes. Will the blepharoplasty also remove the dark circles under my eyes? I have tried every cream and the dark circles are still there. Thank you. Eve, St Paul, MN.
Dear Eve,
Thank you for a great question. While eyelid rejuvenation surgery called Blepharoplasty or eye tuck can remove eye bags, blepharoplasty alone will not remove dark circles under the eyes.
The dark circles, called the naso-jugal folds in medical terms, are caused by an attachment between the muscle and skin under the dark circle to the bone of the eye socket. Because the tissues beneath the dark circle are attached to the bone, they cannot move along with the cheek as the cheek ages and sags. The eyelid tissue above the dark circle sags and is pushed out by fat underneath the eyelid creating the eyelid bag. As the bag gets larger it falls over the dark circle creating a shadow in the dark circle that makes the dark circle much darker and more noticeable.
To correct the dark circle the attachment of the eyelid muscle underneath the dark circle must be released from the bone so that the skin and muscle can slide down into the cheek and the shadow reduced. This attachment is called the arcus marginalis. The removal or repositioning of the fat underneath the eyelid bag will also help reduce the shadow causing the dark circle.
The procedure to release the dark circle from the bone is called an arcus marginalis release and is a part of the modern laser transconjunctival blepharoplasty procedure.
It can be done through a traditional blepharoplasty incision under the eyelashes, but I do my blepharoplasty operation through a laser incision on the inside pink part of the eye called the conjunctiva, a procedure called a laser transconjunctival blepharoplasty. I prefer the transconjuntival incision blepharoplasty because the incision on the outside of the eyelid can change the shape of the eyelid and create the sad eyed or hound dogeyes appearance where the outer corner of the eyelid turns down.
Be sure and ask your surgeon about the transconjunctival blepharoplasty and the arcus marginalis release. If the release is not done then your dark circles will remain even after a blepharoplasty. Some doctors do fat injection to correct dark circles but I prefer the arcus marginalis release. Some doctors inject fillers like restylane into the dark circles but I do not recommend this as I worry about injury to the eye from an injection.
Be sure to find a board certified plastic surgeon who is very experienced in eyelid and blepharoplasty surgery. Read chapter 10 of my book Save Your Face entitled “Don’t Let Just Anyone Touch Your Face”.
For further information visit my Boston Plastic Surgery Practice, read Save Your Face or contact me. Good luck!
Boston, Massachusetts