Good morning Dr Seckel! How are you? First of all, your website is very interesting. As I’ve read, you seem to have a lot of experience with blepharoplasty, how many have you done so far?? I have dark circles since I’m young and they are getting worse and I’ve read it can corrected or improved with an arcus marginalis release. In your archive, you’re talking that you can add alloderm or a piece of rubber. How does the rubber stay in place? After the surgery will your dark circle come back? Finally what’s the price for that surgery? By the way, I’m living in Quebec, which isn’t far from your office in Boston and I’m considering an appointment with you. Thanks a lot! Bye Frank, Quebec, CN.
Dear Frank,
Thank you for your question. I congratulate you on your knowledge and the fact that you are reading to be informed-that is very important when considering plastic surgery, especially so when considering eyelid surgery.
Blepharoplasty or eyelid lift and laser eyelid rejuvenation are my favorite operations. I do them frequently, every week. I have done more than 1500 Blepharoplasty operations and eyelid rejuvenation procedures with the laser during the past 10 years, many with other techniques during the 15 years before I started using the laser blepharoplasty in 1995.
You are correct that dark circles under the eyes and the tired look can be corrected or improved by a technique called the arcus marginalis release during which either fat or a tear trough implant is placed beneath the dark circle under the eye to plump the area. The rubber implant is held in place by the eyelid tissues that seal the implant after surgery. Alloderm can be used but it is very thin and does not plump the circle as much.
The best technique in my experience is fat grafting. During the laser blepharoplasty I use the transconjunctival blepharoplasty technique through a small laser incision on the inside of the lower eyelid to avoid an extrernal scar and preserve the shape of the eyelid. Some fat is removed from beneath the area of the eyelid bulge and then placed lower, beneath the dark circle after the dark circle is released during the arcus marginalis release. Alternatively the bulging lower eyelid fat can be repositioned with a suture rather than grafted.
Fat grafting or fat repositioning is the most widely accepted method, and in my hands gives the best result for most people when the problem to be corrected is dark circles under the eyes. Alloderm does not have enough bulk to correct a deep dark circle. Tear trough implants are more commonly used if the cheekbone is deficient.
Of course you need to be examined to see which technique is best for you.
Dark circles under the eyes can return if the fat graft does not “take” and dissolves. To prevent this I usually place 35-50% more fat than I think will be needed as only 50-65% of the grafted fat survives the fat transplant. This does create a small bulge in the dark circle area for about 6 weeks after surgery until the extra fat dissolves. Most patients are not bothered by this period of recovery, as it is not noticeable to most people. If fat repositioning is done there is minimal fat bulk lost.
Prices vary depending on the complexity of the eyelid rejuvenation operation, a lower laser blepharoplasty can run $5000-7500, the higher cost is usually when additional work like an arcus release and fat grafting or canthoplasty is required. If the upper eyelids are done it is more expensive.
The operation is usually very successful as long as the fat graft survives.
By the way, I do not do fat injection into the eyelid or filler injection into the eyelid using fillers such as Restylane, Sculptra, Hylaform or Cosmoderm for dark circles. In my opinion it is dangerous, the eye can be injured and I have seen some very unsatisfactory results in patients who have had injections done eleswhere
Thank you very much for your question. I would be delighted to see you in Boston. For further information read Save Your Face or contact me.
Boston, massachusetts