Thank you for your email and I would be delighted to review your photos.

Dark circles under the eyes are a very common problem for people all over the world. The treatment of dark circles under the eyes must be directed at the cause of the dark circles. There are many different causes of dark circles under the eyes which I have written about in a previous article Medical Causes of Dark Circles under the Eyes.

Once you have diagnosed the cause then you can plan an effective treatment for dark circles under the eyes.

It is important to understand that everyone has darker skin on the eyelids than the skin of the rest of the face. This is because the eyelid skin is much thinner than the rest of the facial skin and the color of the underlying muscle of the eyelid shows through and creates a bluish or purplish color to the eyelid. This is the normal condition. There is no treatment for dark circles under the eyes caused by the normal darker color of the eyelid skin. If however this dark color is caused by pigment from the sun or an excessive number of blood vessels in the eyelid skin, treatment of this type of dark circle under the eyes can sometimes be treated with an IPL or laser.

The most common type of dark circle under the eye which I see is a condition I call the Arcus Deformity which is a curved, crescent shaped depression below the eyelid just above the cheek bone which casts a dark shadow or dark circle beneath the eyelid. Treatment of dark circles under the eyes caused by the Arcus Deformity requires a procedure called an Arcus Marginalis release and fat repositioning or fat grafting to effectively treat the dark circle under the eye.

Please check my clinical website for correction of dark circles under the eyes for a thorough discussion and photographs of a clinical result of the Arcus release procedure.

Another common condition called dark circles under the eyes is what I call the Hollow Eye Syndrome. In this condition there is actually a hollow beneath the eyelid which creates a severe dark shadow. Treatment of dark circles under the eyes caused by the hollow eye syndrome requires the Arcus Marginalis release and fat grafting but usually extra fat is needed to plump the hollow eye. I take this extra fat from the abdomen around the belly button. The scar is placed inside the belly button and is usually well hidden.

As we age and the eyelid skin becomes lax eye bags develop and worsen the dark circles under the eyes. When eye bags are present I usually treat the dark circles under the eyes by using the protruding fat which causes the eye bag, to plump the dark circle in a laser eyelid rejuvenation procedure which includes the Arcus Marginalis release.

The treatment of dark circles under the eyes requires an understanding of the cause and the application of the proper treatment. I have written a detailed blog on the treatment of dark circles under the eyes which you should read.

If you would like more information on the treatment of dark circles under the eyes or facial rejuvenation in general please read my book Save Your Face or contact me. Since you live in the Boston area you can call my office at 978-369-4499. You should also sign up for my free email newsletter where I write about new treatments for dark circles under the eyes and other facial rejuvenation topics.

Thank you,

Dr. Seckel

Concord, Massachusetts

Thank you for your email. Dark circles under the eyes, which I call the Arcus Deformity,  to differentiate this type of dark circle under the eye from the Tear Trough Deformity. Dark circles under the eyes are very common in India, Central Asia and the Middle East as well as the UK, US and other parts of the world. I correct dark circles under the eyes using a new laser procedure called an arcus marginalis release with fat repositioning or fat grafting. I do this through a laser incision on the inside of the lower eyelid called a transconjunctival blepharoplasty.

People from India and Central Asia have a different and very specific type of dark circle under the eye or Arcus Deformity which requires a specific type of arcus release and a larger fat graft than I do in Caucasians with the Arcus Deformity. In Indians with dark circles under the eyes not only does the arcus marginalis create the dark circle, but the bone just below the lower eyelid is often depressed and fat or implant must be used to correct the hollow eye appearance which occurs as a result.

Interestingly I just performed this surgery last week on a beautiful young lady from Bangladesh who lives in the UK and she has a stunning result. I have also traveled to Bangalore where I did this surgery on a young Indian woman who had dark circles under the eyes and lived in Gujarat.

I would be happy to review your photos if you would like to send them by email. You can read much more about dark circles under the eyes and the transconjunctival laser arcus marginalis release and fat grafting by checking the following link. If you consider having this surgery I would be happy to have you come to Boston for treatment.

Thank you for your question

You may also check the following link: http://saveyourface.com/whatsnew/category/eyes/

To learn more about dark circles under the eyes read Save Your Face or contact me.

Sincerely,

Dr Seckel

Boston, Massachusetts

Blepharoplasty or eyelid tuck, a plastic surgery operation that is done to rejuvenate the eyelid and remove eyelid bags and dark circles under the eyes is the third most common cosmetic plastic surgery operation performed in the United States. When a person has dark circles under the eyes the blepharoplasty has to be done in a different way which includes an arcus marginalis release, a procedure specifically designed to remove dark circles under the eyes.

The results of surgery to remove dark circles under the eyes can be stunning and create a truly refreshed younger look to the entire face. Patients who have dark circles under the eyes often complain of a tired look. The most common complaint I hear is that “people say I look tired when I am not”. The goal is to remove the tired look, the eye bags, the dark circles under the eyes and tighten skin. Blepharoplasty alone does not correct dark circles under the eyes. Blepharoplasty balso does not remove eyelid wrinkles. Eyelid wrinkle removal requires laser resurfacing of the eyelid skin by one of many different new techniques including the Activefx laser skin peel.

One common problem following the standard blepharoplasty for dark circles under the eyes when the transconjunctival laser blepharoplasty is not done, however is that the operation can change the shape of the eyelid. In some cases, after surgery the outer portion of the lower eyelid turns down revealing too much of the white portion of the eye. Technically this is called scleral show, and if it is extreme it is called ectropion and can damage the eye.

More commonly this complication is called the sad eyed look or hound dog eyes. It is very distressing to those patients who have this complication.

Fortunately, the sad eyed look or hound dog eyes following removal of dark circles under the eyes can be avoided by the newer blepharoplasty technique called the transconjunctival laser blepharoplasty.

Traditional “old style” blepharoplasty is done through an incision on the outside skin of the lower eyelid placed just beneath the eyelashes. The surgeon cuts through the skin and the eyelid muscle to get to the fat that is removed to lessen the eyelid bags. Often skin and muscle is also removed to lessen the amount of excess skin on the eyelid.

The problem with the standard “old style” scalpel blepharoplasty technique is that when the surgeon cuts through the muscle which supports the lower eyelid the support for the eyelid is often lost. In addition, the scarring produced by the surgery tends to pull the eyelid down. If the patient has a lax lower eyelid to begin with, the situation is made much worse.

The modern blepharoplasty to remove dark circles under the eyes, called the transconjunctival laser blepharoplasty is done very differently and avoids injury to the supporting eyelid muscle. The conjunctiva is the pink part of the eyelid on the inside called the conjunctiva, thus the transconjunctival laser blepharoplasty. In transconjunctival laser blepharoplasty the incision for a blepharoplasty is made through the conjunctiva on the inside of the lower eyelid and avoids damage to the supporting muscle. The lower eyelid is tightened and an arcus marginalis release performed to correct dark circles under the eyes and the eyelid fat is repositioned. Laser blepharoplasty that is using the laser to make the transconcunctival incision and tighten the skin and muscle, is becoming much more common today as blepharoplasty techniques continue to improve.

The benefit of the transconjunctival blepharoplasty is:

1. There is no visible scar on the outside of the lower eyelid
2. The eyelid shape is not changed
3. Healing time and recovery is usually quicker
4. Bruising is often less
5. The sad eyed look or hound dog eyes is avoided

If you have a lower eyelid that is lax or loose or if your outer lower eyelid turns down, there is a serious risk that you may have the sad eyed look or hound dog eyes or worse if you have an old style blepharoplasty with the incision on the outer eyelid. Instead you should ask that a transconjunctival laser blepharoplasty be used to correct your dark circles under the eyes. Not all plastic surgeons use the transconjunctival blepharoplasty technique. I think it is very important to ask your surgeon about the transconjunctival blepharoplastry if you are considering removal of the dark circles under the eyes, especially if your lower eyelid is loose or lax. If you would like to learn more about dark cirlces under the eyes or the transconjunctival laser blepharoplasty or plastic surgery, contact me or read Save Your Face for further information.

Dr Seckel

Boston, Massachusetts

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.

Dr Seckel

Boston, Massachusetts

The eyelid rejuvenation procedure called CO2 laser resurfacing or laser peel 0f the lower eyelids will not help the dark circles under the eyes unless the problem is only pigment. Laser peel, laser skin rejuvenatiuon, IPL or photofacial are effective methods for eyelid pigment removal. Most dark circles under the eyes are caused by the attachment of the arcus marginalis, a condensation of eyelid tissue beneath the skin of the lower eyelid. Correction of dark circles under the eyes requires a plastic surgery procedure called transconjunctival laser blepharoplasty with arcus marginalis release and eyelid fat repositioning or fat grafting.

Please read the following links which cover the cause and correction of bags and dark circles under the eyes in detail:

Tear Trough or Crescent Deformity

Medical Causes of dark Circles

Removal of Bags and Dark Circles Under The Eye with No Scar

For more information on dark circles under the eyes, eyelid rejuverntion, plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Thank you for your interesting question about dark circles under the eyes. There is great confusion among doctors and patients alike as to what is meant by the expression dark circles under the eyes and about what type of eyelid rejuvenation procedure is best to remove dark circles under the eyes. I agree with you that stress and fatigue have nothing to do with dark circles under the eyes.

I do not agree with the premise that surgery cannot correct the most common cause of dark circles under the eyes. In fact surgery with a transconjunctival laser blepharoplasty and an arcus marginalis release is the only effective treatment for most cases of dark circles under the eyes also called the tear trough deformity or crescent deformity.

The dark circdles under the eyes like condition you describe with capillary leakage and deposition of pigment can certainly cause a brownish red color in the skin of the lower eyelid, but this is a pathological condition, which follows injury and or trauma and is uncommonly permanent and is not what I consider dark circles under the eyes.

Under normal circumstances (that is after not suffering trauma or injury) blood does not leak out of the capillaries and become deposited in the eyelid skin-this does happen after a black eye caused by trauma or surgery (such as rhinoplasty-nose job). But in the majority of people the body’s normal defense mechanisms utilize macrophages-tiny scavenging white blood cells-that come into the eyelid and digest and remove the pigment. This condition, if caused by trauma wound be called an ecchymosis not dark circles under the eyes.

However, in the normal state what many people refer to as dark circles under the eyes are caused by the fact, as you point out, that the eyelid skin is so thin that we can see through the skin, and the purple color of the orbicularis occuli muscle shows through the skin and transmits the dark blue color of the eyelid or dark purple color of the eyelid. I call this normal condition dark purple eyelid color, not dark circles under the eyes. If the attachment of a structure called the arcus marginalis pulls the lower eyelid skin down to the bone and creates a depression, which appears on the eyelid skin as a dark circle beneath the eyelid, then I call this condition dark circles under the eyes.

Dark circles under the eyes is a distinct anatomical entity, technically called the tear trouigh deformity or crescent deformity which is more prominent in many groups. It is I believe familial or genetic and is based on the underlying bone structure of the orbit-the bony cavity supporting the eyeball, and the attachment of the arcus marginalis. Dark circles under the eyes is common and is more common in certain countries, in my experience in the UK, US, and in India. In many people only the arcus marginalis causes the dark circles under the eyes, however I have found that some people also have a bony deficiency which makes the dark circles under the eyes much worse and creates the hollow eyes look. This distinction is very important, as surgical correction of hollow eyes requires an implant as well as fat grafting.

Dark circles under the eyes are very distinct and different from purple eyelid color, which occurs in every human being. Dark eyelid color as I mentioned above is caused by the purple color of the eyelid muscle showing through the thin eyelid skin and is not related to the arcus marginalis which causes the dark circles under the eyes.

There are many other contributing factors to dark color and shadows beneath the lower eyelids-hollow eyes that cast a shadow, superficial veins and blood vessels near the surface, but in most people who have true dark circles under the eyes it is the crescent deformity or tear trough deformity caused by the attachment of the arcus marginalis ligament that causes the appearance. In all people the color of the eyelid skin on the lower eyelid is darker than the surrounding facial skin.

Many dermatologists and others promote the use of laser skin rejuvenation and laser peel procedures on the skin surface to correct dark circles under the eyes, and justify their recommendation by the mechanism you write about. These therapies don’t work because they cannot lighten the color of the eyelid muscle beneath the skin and can cause other problems. In some individuals who have brown pigment in the lower eyelid or numerous superficial blood vessels laser therapy on the eyelid skin can work, but I prefer and use IPL-Intense Pulsed Light-which I think is safer and more effective,

Thank you again for your important question. For more information on lasers, dark circles under the eyes, eyelid rejuvenation, and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Modern plastic surgery can very successfully remove bags under the eyes, puffy eyes, or eye bags. The safest technique, in my opinion, is a procedure called transconjunctival laser blepharoplasty-the procedure is done through a tiny laser incision on the inside of the lower eyelid so that no visible scar is created and the shape of the lower eyelid is not changed.

The eye bags are caused by fat protruding from beneath the eye and pushing the lower eyelid skin out into a bag. Please read the following link: Eye bags

Modern blepharoplasty focuses on fat repositioning, that is repositioning the protruding eyelid fat rather than removing fat. By repositioning eyelid fat into the hollow or dark circles under the eyes, the eye bag or puffy eye is corrected, the dark circle improved, and the hollow eye appearance avoided. This combined with the inner transconjunctival blepharoplasty incision, preserves the shape of the lower eye lid, avoids the sad eyed look, and provides a natural eyelid rejuvenation.

For more information on blepharoplasty, baggy eyelids, and eyelid rejuvenation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

I am very sorry to hear of your distress after having an eyelid phenol chemical peel for eyelid rejuvenation. I use the laser to correct dark circles under the eyes.

When the redness goes away after your peel, the skin will be much lighter-hypo pigmented–this can take 6 months to a year to see the full hypo pigmentation. A new machine called the gentlewaves or IPL or photo facial treatments can help speed the resolution of the redness and broken blood vessel appearance.

Once the redness is gone I do expect that the skin will be lighter in color and smoother in texture. Ask your doctor if there is any evidence of hypertrophic scarring-if there is intervention with IPL and pressure therapy or silicone gel sheeting is necessary.

Once your skin has healed completely, probably after a year, if you still have the dark circles under the eyes or tear rough, then you might consider a plumping operation. If the eyelid skin is stable enough then you may be able to have a transconjunctival blepharoplasty with an arcus release and fat repositioning or fat grafting to fill the tear trough. You will have to wait and see how well the final skin texture and thickness is at that point.

For more information on eyelid rejuvenation, skin care, plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

I am sorry to hear of your experience following the eyelid rejuvenation procedure called blepharoplasty to correct bags and dark circles under the eyes. The problems you mention, hollow eyes, dark circles under the eyes, and the sad eyed look are problems that do occur after the old style incisional blepharoplasty in which an incision is made on the lower eyelid and lower eyelid skin is removed.

There are two main problems that can cause the appearance of hollow eyes, dark circles, and the sad eyed look following blepharoplasty.

First, when too much fat is removed from the lower eyelid the lower eyelid develops the hollow eye appearance. Second, when an incision is made on the lower eyelid the support of the lower eyelid is lost and the lower eyelid droops giving the sad eyed or tired eyes appearance which is technically called an ectropion.

To correct the hollow eye appearance I remove fat from the area around the umbilicus or belly button and transplant the fat into the lower eyelid to plump the hollow appearance. I use an incision on the inside of the eyelid, through the conjunctiva, with a laser, called a transconjunctival laser blepharoplasty. I DO NOT do fat injection with a needle-it is dangerous and does not always work.

I transplant the fat through a tiny laser incision on the inside of the eyelid thus there is no visible scar and the support of the eyelid is not further damaged.

To correct the sad eyed look I do a procedure called the canthopexy, which tightens and restores the ligament, which supports the lower eyelid. This tightens or pulls the lower eyelid back up to a more natural position.

These are complex Oculoplastic procedures and I do not know anyone to refer you to. If you would like to come to Boston, please contact me.

If you would like more information on blepharoplasty, dark circles and eyelid rejuvenmation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Many people feel the same way that you do about dark circles under the eyes. In my experience only plastic surgery can effectively correct the true dark circle under the eye that is technically called the naso-jugal fold.
There is much confusion regarding what people mean when they say they have dark circles under the eyes, often referred to as the tired look. There are 4 different conditions that can cause dark skin under the eyelid which people call dark circles under the eyes:
1. Dark purple eyelid skin color

2. Brown pigment on the lower eyelid skin
3. A hollow eyed appearance in which the lower eyelid is sunken in.
4. A depression or deep line along the lower edge of the eyelid just above the cheek called the naso-jugal fold or tear trough deformity, the true dark circle under the eyelid and most common form of dark circle under the eyes.

1. Dark Purple Color of the Lower Eyelid Skin
When the skin of the lower eyelid is a dark purple or bluish color people often say they have dark circles under the eyes. If you look closely EVERYONE has darker skin color on the lower eyelid than on the skin of the rest of the face. This is because the lower eyelid skin is the thinnest skin on the face, so thin that you can see through the skin and see the purple color of the eyelid muscle showing through the skin. In people with thicker skin the color looks more bluish, but everyone’s lower eyelid skin is darker because of the color of the muscle beneath the thin skin. There are familial and racial differences in skin thickness and muscle color so there is great variation in the darkness of lower eyelid skin. I do not call this normal phenomena dark circles under the eyelid, rather I call this normal phenomena dark purple lower eyelid. The only solution for this problem is to use a cover up make up like Covermark® or Dermablend®.
2. Brown Pigment on the Lower Eyelid Skin
Sun damage to the skin, birth control pills and other medications, and the “mask of Pregnancy” and other metabolic conditions can cause the deposition of brown pigment in the lower eyelid skin. This is not called dark circles under the eyes but is called hyperpigmentation. The treatment is the removal or correction of the underlying cause-stop the medication, sun protection etc. Once the cause is corrected there are several remedies. Skin bleaching agents such as hydroquinone and Kojic Acid can help as can microdermabrasion®. Laser resurfacing or Microlaserpeel®, deep exfoliation techniques can also be helpful. IPL also called Photo Facial can also help. Very goods results can be achieved with these modalities.

3. A Hollow Eye Appearance
Some people have a very sunken in or hollowed eye appearance. This is caused by a deficiency of the normal fat which surrounds the eyeball and plumps the lower eyelid skin. This deficiency of fat can be caused by heredity, racial factors, malnutrition, general disease, dehydration or trauma to the orbital bone that supports the eyeball.
The correction involves the correction of the underlying disease or medical problem when there is a medical cause.
For people who have this appearance because of heredity or racial factors, the fat must be grafted into the lower eyelid to replace the deficiency. I do this by performing a blepharoplasty through an incision on the inside pink portion of the lower eyelid called the transconjunctival approach. This avoids a scar on the outside of the lower eyelid. I then harvest or take fat from an area of the body where the fat will not be missed (hip or abdomen) and transplant the fat to the lower eyelid to plump the lower eyelid.
4.The Naso-jugal Fold or Tear Trough Deformity-the True Dark Circles Under the Eyes.
The true dark circle under the eye is a crease or depression starting at the nose and running towards the outside of the lower eyelid running at the bottom of the eyelid just above the cheek. This dark circle or depression looks dark because it is attached to the underlying bone of the rim of the orbit or eye socket, and the unattached skin of the lower eyelid above the depression is free to move and bulge and creates a shadow which gives the crease a dark color. The cheek skin below the dark circle is also free to move and bulge and is higher than the dark circle, which contributes to the shadow.
The dark circle or naso-jugal fold or tear trough gets worse or deepens as we age because the eyelid above and cheek below begin to sag with aging but the dark circle is attached to bone and cannot sag with the rest of the skin, so the lower eyelid skin hangs over more from sagging and bulging of fat, the depression deepens, the shadow gets worse and the dark circle becomes more noticeable. The dark circles under the eyes or tired look is the first thing that causes most people to seek facial rejuvenation. Usually there are eyelid wrinkles and crow’s feet and facial skin wrinkles occurring at the same time. As the eyelid ages, fat pushes out on the lower eyelid causing eyelid bags.
The dark circle or naso-jugal fold or tear trough is tethered or held tight to the bony rim of the eye socket bone by a ligament called the arcus marginalis.
To correct the dark circle I perform a plastic surgery eyelid rejuvenation procedure called a transconjunctival laser blepharoplasty with arcus marginalis release and fat repositioning or grafting. During the procedure I release the arcus marginalis ligament that frees up the dark circle or naso-jugal fold. Once the dark circle is released the dark circle skin is free to move with the lower eyelid skin and the cheek skin and the dark circle or shadow is lessened. To prevent re-attachment of the arcus marginalis and to plump up the dark circle I place a fat graft underneath the dark circle. Some surgeons place an implant called a tear trough implant under the dark circle but I usually use fat.
Correction of dark circles under the eyes, also called the naso-jugal fold or tear trough deformity requires proper diagnosis. This condition needs to be differentiated from dark purple eyelid color, hyperpigmentation and hollow eyes. The correction of true dark circles under the eyes requires a blepharoplasty operation with arcus marginalis release and fat grafting.

Thank you for your important question.

For more information on dark circles under the eyes, eyelid rejuvenation, blepharoplasty, plastic surgery and lasers read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts