Dear Dr. Seckel,I am 32 and have had dark circles under my eyes all my life. I have tried Teamine, Hydroderm, and all kinds of make up but nothing seems to work. I have seen a plastic surgeon in Boston who recommended a blepharoplasty but I read on your site that a blepharoplasty can make the dark circles worse! I don’t really have hollow eyes just a dark circle that starts next to my nose and runs underneath my eyelid out to the middle of my eyelid. Is this what you call a tear trough deformity? Will a blepharoplasty make it worse? I am starting to notice some bags under my eyes as well and this makes the dark circles worse. You mention an arcus marginalis release and fat grafting, doesn’t the fat make the bag worse? You also talk about a transconjunctival blepharoplasty, but doesn’t that leave loose skin behind. Thank you for your advice. Lizzy, Boston, MA.
Dear Lizzy,
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,
Boston, Massachusetts