Dear Dr. Seckel, How Do You Treat Dark Circles Under the Eyes? Thank you, Betsy, Boston
Dear Betsy,
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
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 also 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.
Concord, Massachusetts
Boston, Massachusetts