Treatment of Dark Circles under the Eyes often Requires Arcus Marginalis Release
The Arcus Deformity-the True dark Circle under the Eye
The most common cause of dark circles under the eyes in patients who seek treatment of dark circles under the eyes or tired eyes in my plastic surgery practice is the Arcus Deformity.
The Arcus Deformity is a dark crescent shaped circle or depression which occurs beneath the lower eyelid starting beside the nose in the corner of the eye and running out toward the side of the face and curving upward towards the outside corner of the eye. This dark circle often appears blue or purple in color and is often called the tired look.
What Causes the Arcus Deformity?
The Arcus Deformity is caused by the fact that a small structure beneath the lower eyelid called the Arcus Marginalis is attached to the bone of the eye socket and also attached to the lower eyelid from underneath. This attachment tethers or holds the lower part of the eyelid close to the bone of the eye socket. The eyelid skin above the arcus attachment is loose and free to move.
The normal fat which is beneath the eyeball pushes out against the lower eyelid which creates a visible bulge on the lower eyelid.
The eyelid skin that is tethered by the Arcus Marginalis cannot move or bulge, and as the fat bulges the lower eyelid above the Arcus Marginalis it creates a shadow or dark circle beneath the eyelid where the Arcus Marginalis is attached to the lower eyelid skin. This is the true dark circle under the eye.
Aging Makes Dark Eye Circles Worse and Creates Puffy Eyes and Eye Bags
As we age and our eyelid skin becomes loose or lax, the eyelid skin also falls or sags over the depression caused by the Arcus deformity and the dark circle gets worse. With aging and excess protrusion of fat against the lower eyelid the Arcus deformity can become quite pronounced.
The treatment for dark circles under the eyes caused by the Arcus Deformity must include release of the Arcus Marginalis and fat repositioning or fat grafting to plump the area of the dark circle.
The traditional plastic surgery treatment for eyelid rejuvenation called the blepharoplasty, during which fat is removed, can actually make dark circles under the eyes worse and create a hollowed eye appearance.
Treatment of dark circles under the eyes that are caused by the Arcus deformity requires a modern blepharoplasty approach which includes release of the Arcus Marginalis and fat repositioning or fat grafting.
I use the transconjunctival blepharoplasty with Arcus release and fat grafting. This treatment is done through a tiny laser incision on the inside of the eyelid called a transconjunctival incision because it goes through the conjunctiva, the pink tissue on the inside of the lower eyelid.
The benefits of the laser transconjunctival incision are:
- No visible scar or incision on the outside of the eyelid
- No change in the shape of the lower eyelid-the traditional scalpel blepharoplasty through an external incision usually weakens the lower eyelid and causes a sad eyed look
- Less bleeding during surgery
- Less bruising after surgery
- Quicker recovery
Beware of Injections to correct Dark Circles.
Many doctors are injecting soft tissue fillers or fat into the arcus deformity to plump the skin. Injections are a blind procedure, you can not see what you are injuring beneath the eyelid skin. While some people have had good results, there have been very many bad results and complications including a reported case of blindness following an injection in England. I do not inject any material into the dark circle.
If Your Eyes Look Tired
If people are telling you that you look tired when you are not, check to see if you have the arcus deformity. Seek an opinion from a board certified plastic surgeon who has experience in eyelid rejuvenation. Bright eyes are the most important facial feature for a youthful look.
Read my free newsletter to learn about the latest new techniques in aesthetics, facial and eyelid rejuvenation and plastic surgery. Read Save Your Face to learn about prevention and non-surgical treatments for facial aging.
Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts