Learn More About
Facial Rejuvenation!

Read "Save Your Face"

Laser Surgery to Remove Eye Bags, Puffy Eyes and Dark Circles under Eyes

Before and after picture of laser removal of dark circles under the eyes.

Are you tired of looking tired? Do people look at your eyes and say did you get enough sleep, are you sick, do you feel well? Eye bags, puffy eyes and dark circles under eyes make our eyes and faces look tired and old. The eyes are our most recognizable and important facial feature and when the appearance of your eyes change, people’s perception of our face changes.

People read our eyes to see how we are feeling and to gain social clues about how to interact with us. You know when someone is happy, sad or angry just by looking at their face and eyes. As we age many of us develop bags under eyes, puffy eyes and dark circles under eyes that distort our look and how we really feel. This is very distressing when we are feeling great and have had a good night’s sleep. Many people who notice aging changes in their eyes consider plastic surgery to regain young fresh looking eyes.

Traditionally a plastic surgery operation called a Blepharoplasty was used to remove eye bags, puffy eyes and dark circles under eyes. While these procedures are effective, the surgery often left the lower eyelid sagging at the corner with a sad eyed look often called the hound dog look. In addition traditional scalpel Blepharoplasty surgery can cause significant bleeding which often leads to prolonged bruising and a painful recovery.

New cosmetic laser eyelid surgery to remove eye bags, puffy eyes and dark circles under eyes has revolutionized the treatment of these conditions. New IPL (intense pulsed light) treatments can lighten the dark blue, purple or black circles under the eyes. These new techniques have revolutionized the way cosmetic eyelid surgery is done.

Before and after picture of laser surgery fro removal of bags under eyes.

What causes eye bags, puffy eyes, and dark circles under eyes?

The eyeball rests on a small pad of fat which is between the eyeball and the bone of the eye socket. This fat is held in tightly by our eyelid muscles and eyelid skin. As we age, our eyelid skin and muscle become loose or lax. The fat pad pushes forward or herniates against the loosened lower eyelid skin and creates a bulge or bag under the eye or a puffy eye.

The bottom of your lower eyelid skin is attached to your cheek bone by a structure called the arcus marginalis. This structure holds the bottom of your lower eyelid tight to the bone so the eyelid does not fall down into the cheek. As the eye bag or puffy eye bulges over the arcus marginalis attachment, a shadow is created beneath the eye bag, and this dark depressed shadow creates the dark circle under the eye. I also call this the arcus deformity, because it is caused by the attachment of the arcus marginalis.

The eyelid skin is also very thin, so thin that you can actually see through the skin and see the color of the eyelid muscle beneath the skin. Since the muscle is purple, the skin overlying the muscle looks purple or blue. If there is sun damage to the skin, brown pigment appears on the lid and the lower lid can appear brown or even black. These factors also create dark colored blue, purple, brown or black circles under the eyes.

In summary eye bags, puffy eyes and dark circles under the eyes can be caused by:

• Loose eyelid skin
• Protrusion or herniation of lower eyelid fat
• Tethering of the lower eyelid to the cheek bone by the arcus
• Thin eyelid skin
• Purple color of eyelid muscle beneath the skin
• Brown pigment on the eyelid skin caused by sun damage

How does laser eyelid surgery to remove eye bags, puffy eyes and dark circles under eyes work?

The laser beam is actually used to make the incision for eyelid surgery. The laser beam seals blood vessels and nerves as the incision is made thus there is less bleeding during the procedure, the most important factor in any eyelid surgery. Because the nerves are sealed, there is less pain.

I use a newer cosmetic laser surgery technique called the Transconjunctival Laser Blepharoplasty which involves making a very tiny laser incision on the inside of the lower eyelid to remove bags under eyes, puffy eyes and dark circles under the eyes. By doing this procedure inside the eyelid, and not cutting through the skin and muscle on the outside, I do not damage the support of the lower eyelid. Thus the natural beautiful shape of the eyelid is preserved.

This transconjunctival laser surgical technique avoids the sad eyed look or hound dog eye that often occurs when an external scalpel is used to make the lower eyelid incision on the outside of the skin.

If my patient has a deep depressed shadow beneath the eye bag, the arcus marginalis deformity, I also release the arcus marginalis through my tiny inside incision or transconjunctival incision. This releases the dark circle shadow under the eye.

I also place small pieces of fat, called fat grafts, on the cheek bone beneath the dark circle to plump the area and prevent re-attachment of the arcus marginalis. This technique plumps the dark circle, corrects a hollow eye appearance, and plumps the cheek for a more youthful look. The entire mid face and cheek area is rejuvenated and looks younger after the arcus marginalis release and fat grafting.

If wrinkles and pigment are present on the eyelid skin I often use a different cosmetic laser surgery application called Fractional Laser Resurfacing to remove the wrinkles and pigment. This is a different laser which does not make an incision, but rather vaporizes sun damaged skin, wrinkles, and pigment.

In summary, the laser surgery technique for treatment or removal of bags under eyes, puffy eyes and Dark Circles involves:

• Laser incision
• Incision inside on pink part of eyelid-the Transconjunctival Laser Blepharoplasty
• Removal of bulging fat causing eye bag and puffiness
• Release of the arcus marginalis which causes the dark circle shadow
• Grafting or placing fat on the cheek bone to plump the dark circle and make the cheek look younger
• Fractional laser skin resurfacing to remove wrinkles and pigment if necessary
• No sutures

Before and after Brow Lift and Eyelid Lift

Before and After Eyelid Lift and Brow Lift

Benefits of this laser surgery technique are:

• Less bleeding
• Less bruising
• Less pain
• Quicker recovery
• No change in shape of eye
• No visible scar

How does IPL-Intense Pulsed Light- remove dark blue, purple or black circles under the eyes?

If you do not have eye bags or puffy eyes but still see dark circles under your eyes, Intense Pulsed Light Treatments, also called photo-facial can remove the dark color from your eyelid skin. Younger people with blue circles, purple circles or brown or black circles under the eyes have thin skin with many small blood vessels called veins, arteries and capillaries which cause the lower eye skin to look blue or purple. Other people have brown pigment which can make the skin look brown or black.

IPl is a light flash treatment that closes the excess small vessels and removes pigment to lighten the color of the lower eye skin. It is very safe, relatively painless and takes only a few minutes. There is no down time. The skin may be pink for a day but no incisions, no surgery, no healing is required.

An eye shield is placed to protect the eye from the light flash. No anesthesia is required and you can go back to work after the IPL treatment. IPL is used to:

• Remove blue and purple circles under eyes
• Remove brown and black circles under eyes
• Requires no anesthesia
• No down time
• Takes only a few minutes
• Requires eye shields to protect the eyes

How do I find a plastic surgeon that performs cosmetic laser surgical procedures?

Cosmetic laser surgery was introduced to plastic surgeons in 1995 yet many have been very slow to adapt to the new technology. The new technology is very expensive and requires a significant investment in lasers.

More importantly, I believe is that these new techniques require a totally different approach to surgery. In traditional plastic surgery the surgical scalpel, and thus the surgeons hand is always in contact with the patient’s skin. With cosmetic laser surgery, all cutting is done with the laser beam and thus direct physical contact with the patient’s skin by the surgeon does not occur.

In my personal view, a different part of the surgeon’s brain is used with this new technique. Older scalpel procedures are manual and the left side of the brain is used. The laser procedure is more of a spatial, visual task that uses the right side of the brain. This requires that the plastic surgeon re-learn basic surgical techniques. After many years of training in a left brain task, re-learning and adapting to a right brain technique is a difficult and challenging task.

You will have to ask your plastic surgeon if he/she performs laser eyelid surgery. The following are good places to start your search:

• Check the American Board of Plastic Surgery to find a board certified plastic surgeon in your area
• Check the American Society of Plastic Surgeons to find a plastic surgeon in good standing in your community
• Check the American Society of Aesthetic Plastic Surgeons to see if your plastic surgeon is experienced in and specializes in aesthetic or cosmetic plastic surgery.
• Check American Society of Lasers in Medicine and Surgery to see if your plastic surgeon has experience and interest in laser surgery

Be careful to choose a plastic surgeon certified by the American Board of Plastic Surgery. There are many non-surgeons who offer laser blepharoplasty. Don’t be fooled, you want a trained board certified plastic surgeon if you are considering laser eyelid surgery.

Before and after total laser eyelid rejuvenation.

Laser eyelid surgery is a very significant advance in eyelid rejuvenation. Do your homework and find an expert. Let the laser help you look as good as you feel.

For more information on cosmetic laser surgery call 978-369-4499 or email me.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts