Dear Dr. Seckel, I have dark circles under my eyes. One doctor has suggested fat injections or fat grafting to plump the dark circles. Another doctor I saw recommended a filler injection with Restylane into the dark circle. I have read that surgery can be done for dark circles. What is your opinion as to the best treatment for dark circles? Thank you, Carol, Boston, Massachusetts
Dear Carol, Thank you for your question about the treatment of dark circles under the eyes. I have a very strong opininion about the best dark circle treatment. I use open fat grafting and an arcus marginalis release to correct dark circles. I do not do fat injections or soft tissue filler injections for dark circles under the eyes. I have treated hundreds of patients over many years for dark circles and have been very happy with the techniques I use, which I will describe in more detail below.
Open fat grafting is different from fat injection or soft tissue filler injection to correct depressions beneath the eyelid. In open fat grafting, intact pieces of fat are placed into an area under direct vision through a small incision. Most commonly, in my practice open fat grafting is done to correct hollow eyes or dark circles under the eyes. Unlike fat injections in which a fat solution is injected by a needle, open fat grafts are placed under direct vision and can be accurately put into position.
Why Add Fat to the Eyelid?
Patients with hollow eyes lack enough fat to support the eyeball and have a normal full eyelid. Patients with dark circles under the eyes have a depression beneath the lower eyelid which can be plumped or filled with fat to remove the dark circle. In both of these situations it is beneficial to add fat to the lower eyelid region.
Problems with Fat Injection Techniques
• Fat injection is a blind procedure-When fat is injected into the eye area with a needle or small tube, the doctor cannot see exactly where the instrument is and what eye structures are near. There is risk, in my opinion, of injuring blood vessels, eye muscles or even the eye when doing an injection of fat.
• Survival of fat is inconsistent-Typically fat is removed from the hip or other area, treated outside the body and then re-injected. Many fat cells are damaged and do not survive. It is very difficult to get the right amount of fat to survive and get the proper correction desired.
• Accurate placement of fat is difficult-Often fat is placed to low beneath the eyelid and creates a lump below the dark circle or hollow eye and actually makes the problem worse.
• Injected fat survival is irregular-Inconsistent fat survival often results in visible lumps.
Benefits of Open Fat Grafting Technique
• Fat is placed accurately under direct vision of surgeon-Open fat grafting to correct hollow eye and dark circles under the eyes is done, in my practice through a small laser incision on the inside of the eyelid. This allows direct vision of the depression that needs to be filled; a properly sized piece of fat can be placed accurately into the area where the fat is needed. See result of open fat grafting in before and after photo of my patient below:
• Intact fat of proper size can be used-A composite (whole) fat graft will survive or “take” after losing about 40% of its volume in the first 3-6 weeks during which time new blood vessels grow into the fat to keep the fat alive. I am able to accurately predict the proper graft size to correct the hollow eye or dark circle.
• Smoother graft contour-in my experience a composite graft almost always has a uniform smooth appearance after healing-my opinion is that fewer fat cells are lost than with injection technique.
Open Fat Grafting or Fat Repositioning for Correction of Eyelid Deformities
Fat grafting is most commonly used, in my experience, to correct depressions or deformities in the lower eyelid. Typically fat is used to make a hollow eye look less hollow or to correct dark circles under the eyes.
Most often, in patients with facial and eyelid aging, the lower eyelid is puffy or has bags under the eyes. In these situations, the fat that is causing the puffy eye or eye bag is removed from the protruding area and grafted back into the lower eyelid, on the cheek bone just beneath the lower eyelid to plump the dark circle which creates an aged look to the eyelid.
When fat is taken from one position on the eyelid-the bag or puff, and replaced as a graft to plump a dark circle, this procedure is called fat repositioning rather than fat grafting.
Excellent Accurate Results
In my experience, the ease of accurate placement, and the excellent survival of the composite fat graft have resulted in excellent and dramatic correction of the hollow eye and dark circles under the eyes.
• Eye injury is avoided
• Lumps or irregularities are minimal
• Accurate correction of hollowness and dark circle is possible
To learn more about open fat grafting to correct dark circles under the eyes call 978-369-4499 or email us. Read Save Your Face to learn about prevention of eyelid and facial aging.
Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts