The eyes are the “window to the soul” and our most frequently viewed facial feature and unfortunately the first feature to show the signs of facial aging. Usually by the 30’s we begin to see crow’s feet, wrinkles, eye bags, dark circles under the eyes, and the start of eyelid hoods or hooding of the eyes.

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Traditional plastic surgery called the blepharoplasty can reverse many of these eyelid aging changes however newer methods using laser blepharoplasty and other laser eyelid rejuvenation techniques are vastly improved methods for eyelid rejuvenation. Newer, non-surgical eyelid rejuvenation techniques such as Botox and non-surgical eyelid skin tightening techniques such as the Aluma radiofrequency skin tightening device can improve and help prevent eyelid aging changes such as eye hooding, wrinkles, eye bags, and dark circles under the eyes.

The laser eye lift, which I call the “modern blepharoplasty”, combines new laser and non-surgical skin rejuvenation technology to produce dramatic eyelid rejuvenation without many of the drawbacks of traditional blepharoplasty.

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The laser eye lift combines the advantages of nearly bloodless laser incisional methods with non-surgical skin tightening and skin peeling methods for removal of wrinkles and tightening and freshening of the eyelid skin. For the first time we can achieve total eyelid rejuvenation, not just removal of eye bags and hooding of the eyes, but smooth young looking eyelid skin with fewer wrinkles and less sun damage and aging changes and removal of dark circles under the eyes.

In addition by using the laser to make a tiny incision on the inside of the lower eyelid (the transconjunctival blepharoplasty) we can avoid a visible scar on the outside of the lower eyelid. The transconjunctival blepharoplasty technique also avoids any change to the beautiful lower eyelid shape, a common and troublesome complication of traditional scalpel blepharoplasty with an external eyelid incision. In addition, with the transconjunctival blepharoplasty it is possible to release the arcus marginalis and thus truly remove dark circles under the eyes.

Advantages of the laser eyelid rejuvenation are:

1. Faster Surgery
2. Less bleeding
3. Less Bruising
4. Quicker Recovery
5. No visible scar on lower eyelid
6. No change in lower eyelid shape
7. Removal of Dark Circles Under The Eyes
8. Freshening of Lower Eyelid Skin with Skin Tightening and Wrinkle Removal

The laser eyelift consists of 4 steps:

1. Laser upper blepharoplasty for removal of hooding of the upper eyelid
2. Transconjunctival lower blepharoplasty with arcus marginalis release and repositioning or grafting of fat to remove the dark circles and bags under the eyes
3. Laser tightening of the lower eyelid and a procedure called canthoplasty to tighten the lower eyelid and remove eye bags
4. ActiveFX Laser eyelid skin peel to remove wrinkles, sun damage , and tighten lower eyelid skin

The combination of these 4 steps provides truly total eyelid rejuvenation for the first time, something which the traditional scalpel blepharoplasty just cannot achieve. Furthermore with the advantages of less bleeding and bruising, recovery time is usually shorter than with traditional scalpel blepharoplasty.

During step 1of the laser blepharoplasty, the laser is used to remove the loose upper eyelid skin which is creating the eye hoods. After the loose skin is removed access is gained to the canthal ligament, which supports the lower eyelid, through the upper eyelid incision, so that the lower eyelid may be tightened in step 3 to restore the shape of the lax lower eyelid.

Step2, the transconjunctival laser blepharoplasty corrects aging changes of the lower eyelid. The conjunctiva is the pink portion of the inner lower eyelid, thus when the laser incision is made on the inner side of the lower eyelid it is called a transconjunctival incision. This approach avoids a visible scar on the outside of the lower eyelid. In addition, the supporting skin and muscle of the lower eyelid is not violated and thus the beautiful shape of the eyelid is not changed. One major drawback of traditional scalpel blepharoplasty is weakening of the lower eyelid and a downward turn of the eyelid referred to as an ectropion, also called the sad eyed look or hound dog eyes. The transconjunctival blepharoplasty avoids this complication.

During step 2 the eyelid fat which is causing the eye bag in either removed or repositioned so that it no longer causes the bulge or eye bag. In addition, the arcus marginalis, a condensation of eyelid tissue which tethers the lower eyelid skin and causes the dark circle under the eye, is released allowing the dark circle to ‘open up”. In addition fat is placed beneath the dark circle to plump the dark circle. The combination of fat repositioning and arcus marginalis release remove the dark circle under the eyes.

Step 3. During step 3 the laser is used to tighten the lower eyelid skin by shrinking the lower eyelid tissues through the transconjunctival incision. In addition, the canthal ligament, which supports the lower eyelid, is tightened with a suture placed through the upper lid incision, a procedure called a canthopexy. These two procedures tighten the lower eyelid and also provide a small amount of upper cheek lift.

Step 4. Step 4 involves refreshing, smoothing, and tightening of the lower eyelid skin using the ActiveFX laser eyelid peel. This new high tech procedure allows for rejuvenation of the skin surface of the lower eyelid and thus total eyelid rejuvenation. In the past with traditional laser blepharoplasty, hoods and bags were removed but the eyelid skin remained wrinkled and old looking. With today’s new laser blepharoplasty and eyelid rejuvenation techniques a truly fresh and rejuvenated eyelid appearance is possible.

The laser eye lift is the modern blepharoplasty approach which provides total eyelid rejuvenation. For further information read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Concord, Massachusetts

978-369-4499

Thank you for your question. I congratulate you on doing your reading about plastic surgery and eyelid rejuvenation. The dark circles under the eyes that you mention do not sound like the tear trough deformity. The tear trough deformity occurs much later when the cheek fat pad begins to descend down from the cheek bone into the cheek, which usually does not occur until the 50’s or 60’s.

Many young people have dark circles under the eye which you describe and in my opinion it is usually caused by the attachment of the arcus marginalis, which is a small condensation of the fascia beneath the lower eyelid which is attached to the eyelid skin, and tethers the lower eyelid skin to the bone of the eye socket creating a depression which in turn creates a shadow, the dark circle under the eye. If a routine blepharoplasty is done and the arcus marginalis is not released, and too much fat is removed the dark circle under the eye can be accentuated and create hollow eyes.

In younger people like you when I do a transconjunctival laser blepharoplasty I release the arcus marginalis and reposition the eyelid fat or place a small fat graft to plump the depression and prevent the arcus from reattaching. This small amount of fat fills the dark circle only, it does not create or worsen the eyelid bag I also am very careful to not remove too much fat during the blepharoplasty because I don’t want to create the hollow eye appearance.

I do almost all of my blepharoplasty operations using the transconjunctival laser blepharoplasty approach. I avoid making the external blepharoplasty incision because the traditional blepharoplasty with an external incision weakens the lower eyelid support, and the lower eyelid turns down creating the sad eyed look or hound dog eyes also called an ectropion or scleral show. The transconjunctival laser blepharoplasty is done through a small incision on the inside of the lower eyelid, the pink part called the conjunctiva, thus the lower eyelid support is not weakened and the natural beautiful eyelid shape is preserved.

Many people worry that not making an external blepharoplasty incision and not excising lower eyelid skin will leave loose skin behind. This is rarely a problem. I tighten the lower eyelid skin during the transconjunctival laser blepharoplasty by shrinking the tissues beneath the skin with the laser which tightens the lower eyelid skin sufficiently. I also frequently tighten the lower eyelid by doing a canthopexy, that is tightening the support ligament of the lower eyelid. This maneuver makes skin excision unnecessary during blepharoplasty. In the rare case in which some skin removal is necessary a pinch blepharoplasty can be done.

The combination of transconjunctival laser lower blepharoplasty with arcus marginalis release and fat repositioning or grafting is a newer way to treat dark circles under the eyes and I call it the modern blepharoplasty. The advantages are a more effective correction of the dark circles under the eyes, no visible scarring, no change in the shape of the lower eyelid, and in my experience a much faster recovery.

I hope this answers your question.

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

Thank you,

Dr Seckel

Boston, Massachusetts

The surgeon is right to worry about ectropion and hound dog eyes after a lower eyelid blepharolasty if you have large eyes or your eyes protrude a bit.

For eyelid rejuvenation of the lower eyelids in your situation I recommend a Laser transconjunctival lower blepharoplasty (no skin incision on the outside thus little risk of losing lid support) with a canthopexy. This operation also corrects dark circles under the eyes. If there is eyelid skin excess excess a small pinch blepharoplasty can be done at the corner of the eye to correct this. After the pinch blepharoplasty the eylid muscle can be tightened by an orbiculopexy which tightens the lower eyelid muscle for additional lower eyelid support in addition to the canthopexy.

Check the following links:

Laser Transconjunctival Blepharoplasty

Pinch Blepharoplasty

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

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

The dark color you mention starting at the corner of your eyes is called a Tear Trough Deformity, commonly called dark circles under the eyes. You can read about what causes dark circles under the eyes in Chapter One of my book Save Your Face.

The dark circle under the eye is normal, but gets worse as we age. The only method I know to correct it is a transconjunctival laser blepharoplasty with arcus marginalis release and fat repositioning or grafting or placement of a tear trough implant. I have written a great deal about eyelid rejuvenation, the correction of dark circles under the eyes and you can read about this by checking the blogs on my website saveyourface.com by following the link below:

Dark Circles Under The EyesAs you know I do not recommend using fillers like Restylane, Radiesse, Cosmoplast, Sculptra and others to correct dark circles under the eye. The risks of filler injection around the eyes to the eye is too great, results are often unsatisfactory with lumps and swelling, and the companies that make the fillers do not recommend it.

If you would like to send me your photos, which I will keep confidential I will be happy to give you a more detailed answer.For more information on dark circles under the eyes, fillers and plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you,
Dr Seckel

Boston, Massachusetts

Thank you for your very sophisticated question. You have a good knowledge of plastic surgery of the eyelids.

Dark circles under the eyes are the one facial problem that cannot yet be corrected with non-surgical facial rejuvenation techniques. While the ActiveFX laser skin peel orLaserLyte Peel can improve eyelid wrinkles and skin aging changes, neither the LaserLyte Peel or the LaserLyte Lift can correct dark circles under the eyes. To correct dark circles under the eyes and remove puffy eyes or eye bags under the eyes a transconjunctival laser blepharoplasty with arcus marginalis release and fat repositioning or grafting is required.

The two procedures can be sequenced either way. I frequently do the transconjunctival laser blepharoplasty with arcus release and fat repositioning and the ActiveFX laser skin peel at the same operation, thus correcting eye bags, dark circles under the eyes, eye bags, puffy eyes, and eyelid aging changes such as eyelid wrinkles and skin irregularity and laxity at the same time.

By combining both procedures you will have the benefit of the correction of the eyelid wrinkles and dark circles under the eyes and eye bags at the same time. When these two procedures are combined I usually do a canthopexy and orbiculopexy to tighten the eyelid and prevent ectropion or sagging of the corner of the lower eyelid by skin tightening created by the laser peel.

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

Thank you,

Dr Seckel

Boston, Massachusetts

You are correct that the plastic surgery operation called a brow lift or eyebrow lift accomplishes both elevation of the eyebrow and some improvement in the hooding of the eyelids.

However the brow lift rarely corrects the excess eyelid skin to a
satisfactory level. Usually a small excision of upper eyelid skin called a blepharoplasty or eyelid lift is also required for effective eyelid rejuvenation. I use the laser in a procedure called a laser blepharoplasty or eye lift to accomplish this.

The normal male eyebrow position is lower and less arched than that of female. If the plastic surgeon pulls the eyebrow high enough to correct excess eyelid lid skin or the hooding of the upper eyelid the result can “feminize ” the eyebrow.

For more information on eyelid rejuvenation, brow lifts and plastic surgery read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Thank you very much for your inquiry about eyelid rejuvenation.

The short answer to your question is yes, eyelid rejuvenation refers to
the correction of loose skin, puffiness, eyelid wrinkles and dark circles under the eyes, eyelid aging changes which make the face look tired.

Some patients who only have eyelid wrinkles and old looking skin can have very effective eyelid rejuvenation with a non-surgical facial rejuvenation procedure called an ActiveFX Laser eyelid peel and Botox.

Most patients who have dark circles under the eyes, eye bags, puffy eyelids and hooding of the eyes also need an eyelid rejuvenation procedure called a
blepharoplasty to make the lower eyelid look refreshed and younger, and remove the tired look.

For removal of dark circles under the eyes, eye bags, and puffy eyes I use a procedure called transconjunctival laser blepharoplasty with arcus marginalis release and fat grafting or fat repositioning. This procedure involves a tiny incision on the inside of the eyelid to correct the aging changes. The benefit is that there is no visible scar on the outside of the eyelid and the natural shape of the eyelid is not changed.

For more information on eyelid rejuvenation, laser blepharoplasty and plastic surgery read Save Your Face or contact me.

Sincerely,

Dr Seckel

Boston, Massachusetts

Congratulations on being well read and up to date on the latest eyelid rejuvenation techniques in plastic surgery!

The transconjunctival laser blepharoplasty with arcus marginalis release and fat grafting or repositioning is the best new method for removing eyelid bags and dark circles under the eyes. I do this procedure with a laser and in my opinion it is the safest and best way to do the operation.

There are many advantages to the new laser eyelid rejuvenation techniques.

First, with traditional scalpel blepharoplasty an incision is made on the outside of the lower eyelid which cuts through the supporting muscles of the lower eyelid and skin and muscle are removed. The result is that after healing the lower eyelid can turn down and have a “sad eyed look” called “hound dog eyes” or technically an ectropion. If you look at many people who have had the standard blepharoplasty you will see this phenomenon.

The transconjunctival laser blepharoplasty avoids ectropion by placing the incision on the inside of the eyelid through the conjunctiva, the pink portion of the inner eyelid, thus the muscles are not cut, eyelid support stays in tact and there is no visible incision on the outside of the eyelid.

The arcus marginalis release is the only method for removing dark circles under the eyes that works in my opinion. Usually during this maneuver fat is placed beneath the dark circle under the eyes to plump up the skin and remove the shadow which creates the dark circle under the eyes.

The benefits of using the laser for blepharoplasty is that the laser seals the blood vessels as it cuts thus there is much less bleeding during laser blepharoplasty. Since bleeding is the most dreaded complication of blepharoplasty, I feel the laser is a much safer technique.

If you want to read more about this technique follow this link.

For more information on laser blepharoplasty, eyelid rejuvenation and plastic surgery read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

I agree with you. If you have dark circles under the eys and your eyelids are sunken in a Transconjunctival Blepharoplasty with fat removal would only make you look worse.

A Transconjunctival laser blepharoplasty with an Arcus Marginalis release and a fat graft or a tear trough implant to fill in the hollow would give the eyelid a more natural appearance and correct the dark circles under the eyes. I would have to examine you to be sure but I am guessing this would be the eyelid rejuvenation procedure which would satisfy you the most. I do this operation with a laser.

Following this procedure removal of eyelid skin is not usually necessary because the fat graft or implant puffs the hollow and tenses the skin for a nice youthful look.

If skin removal is necessary a small pinch blepharoplasty excision can be done from the outside corner-but at 25 years old I doubt very much if you need skin excision. I believe the reason you like the look when you pull the skin back is that you are tightening the structures underneath the skin and forcing the fatty inside the eyelid down into the hollow.

These operations are very complex, require experience, and especially in a young person like you it is essential that they be performed correctly.

For more information on eyelid rejuvenation, transconjunctival blepharoplasty, dark circles under the eys, and non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts