Eye bags and puffy eyes are caused by a structural problem beneath the eyelid, and eye creams just cannot reach the cause of the eye bag or puffy eye and thus cannot correct eye bags or puffy eyes.

Nearly everyone over 30 begins to notice eye bags, puffy eyes and dark circles under their eyes, Billions of dollars are spent each year on skin creams to remove eye bags, puffy eyes and dark circles under the eyes and plastic surgery, called blepharoplasty which is done to remove eye bags and puffy eyes is the third most common plastic surgery operation done in the United States.

What Causes Eye Bags, Puffy Eyes and Dark Circles under the Eyes?

Eye bags, also called eyelid bags, puffy eyes, tired eyes, and dark circles under the eyes, are caused by protrusion or herniation of the fat which lies beneath the eyelid and which normally is held directly beneath the eyeball. The reason the fat is beneath the eyeball is that it acts as a shock absorber preventing the eyeball from coming into contact with the bone of the eye socket. The eyelid is positioned directly over this supporting fat pad and holds the fat in place directly below the eyeball so that the fat can serve its function.

The problem of eye bags and puffy eyes occurs as we age because as the skin of the eyelid ages it loosens, becomes less elastic, and begins to sag and lose tone. As the eyelid loses tone it cannot hold the fat within the bony orbit or eye socket beneath the eyeball, and the fat pushes forward against the undersurface of the weakened eyelid and creates the eye bag , puffy eye, or eyelid bag.

This pushing forward on the eyelid and creating an eye bag, eyelid bag or puffy eye is technically called fatty orbital herniation, because the fat herniates or protrudes from the bony orbit or eye socket and creates a bulge or eye bag or puffy eye. To herniate means to project through an abnormal opening, like the bulge produced by a hernia on the lower abdomen. Eye bags or puffy eyes are a hernia of the eyelid.

The other eyelid aging sign is called dark circles under the eyes. Technically this is called the arcus deformity and is caused by a tethering of the dark circle skin from underneath the eyelid skin by a structure called the arcus marginalis, which is discussed below. The dark circles under the eyes are essentially a shadow created by the overhanging eye bag or puffy eyelid.

How Are Eye Bags and Puffy Eyes Removed Traditionally?

Eye bag removal has traditionally been done with a plastic surgery operation called a blepharoplasty. During the traditional eye bag surgery the plastic surgeon made an incision on the lower eyelid just beneath the eye lashes, exposed the underlying fat causing the eye bag or puffy eye, and removed the fat and also removed some of the skin which had been stretched into the eye bag. Although the blepharoplasty does remove the eye bag or puffiness, there are several problems with this traditional eye bag or puffy eye surgery.

First, the incision through the eyelid weakens the eyelid skin and muscle which supports the eyelid and holds the eyelid tight against the eyeball. As a result of weakening of the support for the eyelid, the eyelid often turns down or sags after a lower eyelid blepharoplasty. Technically this is called an ectropion or scleral show, but in lay terms it is referred to as the sad eyed look or hound dog eyes. It is a terrible stigma of the old scalpel blepharoplasty operation. The ectropion can also have serious implications for the eye ball itself. When the ectropion is severe, the eyeball can dry out, develop a corneal ulceration, and threaten the eye. Often corrective surgery called a canthoplasty is required.

Because of these serious complications from traditional eye bag and puffy eye surgery new modern blepharoplasty techniques have been developed to remove eye bags and puffy eyes without damaging the support of the eyelid. The newer, more modern blepharoplasty technique is called a transconjunctival blepharoplasty. The conjunctiva is the pink part of the lower eyelid on the inside of the lower eyelid, and during the transconjunctival blepharoplasty the incision is made on the inside of the lower eyelid and the fat exposed and the tissues tightened. The transconjunctival blepharoplasty can be used to remove eye bags and puffy eyes without damaging the outer supporting eyelid muscle and tissues and thus the eyelid support remains in tact and there is little risk of ectropion or hound dog eyes after removal of the eye bags and puffy eyes.

Remove Eye Bags but Avoid Hollow Eyes and Correct dark Circles Under The Eyes!

Another serious drawback to traditional blepharoplasty for eye bags and puffy eyes is that often the surgeon removes too much of the fat that was causing the eye bag. The result of too much fat removal during blepharoplasty is that after removal of the eye bag the patient is left with a hollow eye appearance. This is a very distressing problem for patients, so distressing that many patients choose to have additional surgery to transplant fat back into the eyelid to correct the hollow eye appearance after eye bag and puffy eye removal.

Newer more modern blepharoplasty techniques for eye bag and puffy eye correction do not remove fat but reposition the fat or graft the fat into a better position to create a more youthful eyelid look and remove dark circles under the eyes. When a person has eye bags and puffy eyes there is almost always a dark circle under the eye directly below the eye bag. These dark circles are called the naso-jugal fold or tear trough deformity and is caused by the attachment of a small structure called the arcus marginalis. The arcus marginalis is attached to the bone of the eye socket and is also attached to the underside of the lower eyelid just below the eye bag. The arcus marginalis holds the lid down or tethers the lower eyelid to the bone right at the dark circle, creating the tear trough deformity, so the upper part of the lower eyelid, the eye bag falls over the dark circle or tear trough, and makes the dark circle shadow worse.

Newer more modern blepharoplasty involves a transconjunctival blepharoplasty, which avoids ectropion, followed by release of the arcus marginalis, which releases the dark circle or tear trough deformity. Next, the protruding eyelid fat is not removed, but the bulging fat is placed beneath the dark circle, to plump the dark circle or tear trough, reduce the shadow, reduce the eye bag and puffy eye and avoid the hollow eye.

This is a new technique for removal of eye bags, puffy eyes and dark circles under the eyes and not widely practiced by plastic surgeons yet. As always there will be a 10 year delay between this new medical discovery and the adoption of the technique by the majority of surgeons. That is just the way new technology develops in surgery.

Festoons Can Look Worse After Old Style Blepharoplasty for Eye Bags and Puffy Eyes.

A festoon is often mistaken for an eye bag or puffy eye. In fact a festoon is a puffy swelling on the cheek just below the lower eyelid and is not an eye bag or puffy eye as many people think. The festoon is cheek skin and cannot be removed during a blepharoplasty. It is a puffy swelling at the top of the cheek just below the dark circle under the eye just below the eye bag. he technical term for a festoon is a malar bag.

Most people do not understand what a festoon is and mistakenly believe that the festoons can be corrected by the blepharoplasty for eye bags or puffy eyes. In fact, after a blepharoplasty for eye bags or puffy eyes is done, the festoons can look more prominent and make the face look worse!

For many years there was nothing that could be done to remove festoons, however new technology holds promise that we may soon be able to significantly improve festoons. A lateral eyelid /cheek lift can often remove festoons. New laser skin tightening technology may also soon be used to remove festoons.

The Modern Laser Blepharoplasty for Removal of Eye Bags, Puffy Eyes, and Dark Circles Under The Eyes- Transconjunctival laser arcus marginalis release with preservation and repositioning of orbital fat.

I have used the laser exclusively to perform all of my blepharoplasty operations for the past 14 years, over 2300 cases. The new modern way to remove eye bags and puffy eyes is to use the laser to perform a transconjunctival blepharoplasty with arcus marginalis release to release the dark circles under the eyes and correct the tear trough deformity, and fat grafting to plump the dark circle and prevent the hollow eye look. This technique prevents ectropion, sad eyed look, and hound dog eyes and gives the lower eyelid a very young, smooth look with no eye bags and no change in eyelid shape. The results of my experience are published in the Journal Plastic and Reconstructive Surgery. The benefits of using the laser transconjunctival blepharoplasty with Arcus marginalis release and Fat grafting are:

1. No bleeding
2. Minimal bruising
3. quicker recovery
4. No visible scar on the eyelid
5. no change in the beautiful eyelid shape
6. quicker surgery with less anesthesia time
7. Correct the Tear Trough deformity or dark Circle Under the Eye
8. Avoid Hollow Eyes
9. Remove Eye Bags and Puffy Eyes
10. Excellent Results

Add The Lux2940 Fractional Laser Peel of The Lower Eyelid for Eyelid Wrinkle Removal and Total Eyelid Rejuvenation

All blepharoplasty procedures for eye bags and puffy eyes still do not totally rejuvenate the lower eyelid unless something is done to correct the eyelid wrinkles, brown spots, “crêpe” skin and other eyelid aging skin changes. The new Lux2940 Fractional Laser Peel is a revolutionary new eyelid skin peeling technique that removes eyelid wrinkles, sun damage, and aged skin and creates new fresh youthful looking skin on the eyelid. This new 2940 laser peel can be done at the same time as the blepharoplasty so that true eyelid rejuvenation is possible, removal of eye bags, puffy eyes, dark circles under the eyes, and removal of wrinkles and eyelid skin aging changes.

This is the modern approach to eyelid rejuvenation, Total Laser Eyelid Rejuvenation for removal of eye bags, puffy eyes, dark circles under the eyes, eye wrinkles, and sun damage, all with no change in eyelid shape, no hound dog eyes, no sad eyed look, no hollow eyes, all with the help of the laser and the newest most modern eyelid rejuvenation techniques, the laser and the 2940 laser peel.

To learn more, contact me or read Save Your Face or follow this link.

Dr. Seckel,

Boston, Massachusetts

Concord, Massachusetts

978-369-4499

Dark circles under the eyes has often been referred to as the tear trough deformity or crescent deformity but experience particularly with tear trough implants designed to correct the tear trough deformity has often failed to correct dark circles under the eyes, particularly the portion of the dark circle under the eye near the nose, often the deepest and most troubling part of the dark circle under the eye.

The tear trough deformity is most commonly found in older individuals, is a sign of more advanced facial aging and is seen as a depression running beneath the cheek bone or Zygoma out toward the side of the face. The key event in the production of the tear trough deformity is the sagging or downward displacement of the cheek into the lower portion of the face, a condition referred to as the herniation of the cheek fat pad.

A youthful appearance of the face is characterized by a full youthful cheek, a plump cheek appearance with the fat and skin of the cheek high attached to the cheek bone. Remember the “chubby cheeks” of childhood. As facial aging occurs and the facial tissues become lax and descend in the face, the cheek fat pad, also called the malar fat pad, descends into the midface, leaving a hollow beneath the cheek bone which is the tear trough deformity, because tears roll out to the side of the face rather than straight down the cheeks as they did in childhood. The arcus marginalis ligament and other fascial attachments of the cheek on the cheek bone do tether the skin to the higher cheek bone and contribute to the tear trough deformity, but the descent of facial skin and the malar fat pad are the predominant event causing the tear trough deformity. The true tear trough deformity occurs in the 5^th or 6^th decade in most patients I see-this is very different from my experience with patients complaining of dark circles under the eyes.

Patients seeking correction of dark circles under eyes are typically in their 20’s and 30’s. have noticed the dark circles all of their lives, and typically do not have facial sagging and herniation of the cheek fat pad. They complain of a dark circle and depression which creates a shadow which is beneath the lower eyelid starting at the nose and running out toward the side of the face. However, this depression curves upward to follow the lower eyelid but does not turn downward and extend into the cheek as does the tear trough deformity. As pointed out in several previous articles the dark circle under the eye is caused by the attachment of the arcus marginalis a condensation of tissue beneath the eyelid, attached to the bone of the eye socket, which tethers the lower eyelid skin to the bone creating a depression which creates a shadow beneath the lower eyelid. With aging of the eyes and skin, laxity of the lower eyelid skin and fat creates a slight bulge of the lower eyelid above the dark circle under the eye, which I now call the arcus deformity, and causes the dark circle to be more noticeable usually starting in the 30’s and early 40’s

The arcus marginalis, the tissue beneath the lower eyelid, attached to the bone of the eye socket and holding the lower eyelid skin to the bone, plays a causal role in both dark circles under the eyes and the tear trough deformity. However it is very important to make the distinction, and understand the difference between the arcus deformity or dark circle under the eye and the tear trough deformity because successful treatment requires very different approaches.

Dark circles under eyes which I call the arcus deformity or arcus marginalis deformity, occurs in younger patients who seek correction in their 20’s and 30’s and requires a release of the arcus marginalis and fat repositioning or fat grafting to correct. The procedure I use is called a transconjunctival blepharoplasty with arcus marginalis release and fat grafting or repositioning. This condition is to be differentiated from dark eyelid color also often referred to as dark cirlces under the eyes.

A tear trough implant, in my experience, frequently fails to extend beneath the dark circle near the nose and is often displaced toward the side of the cheek by the action of the overlying lower eyelid muscle. In older patients who also have puffy eyes or eye bags, the dark circle under the eye is accentuated by the shadow cast by the protruding eyelid skin and fat above the dark circles under the eyes. These patients are also dramatically improved by the arcus marginalis release and fat repositioning.

The tear trough deformity occurs in older patients and includes a depression in the cheek toward the side of the face and is seen when the cheek has descended down lower in the face. While tear trough implants can be useful when the tear trough deformity occurs, in my experience a cheek lift, mid face lift or face lift which replaces the cheek or malar fat pad higher in the face , back on the cheek bone where it belongs is a more successful approach.

These are my own opinions and observations based on my considerable experience in dealing with facial and eyelid aging over the past 25 years. For more information of facial and eyelid aging contact me or read Save Your Face. Be sure to sign up for my free email newsletter.

Dr. Seckel

Concord, Massachusetts

Boston, Massachusetts

To better understand the treatment of dark circles under the eyes I will discuss the various types of dark circles under the eyes that I encounter in my plastic surgery practice and my understanding of the cause of the dark circles, and what I feel is the most effective treatment to remove the dark circles under the eyes.

Understand that the eyelid skin appears darker than the surrounding facial skin in all people-dark eyelid color is the normal condition and is caused by shadows created by the overhanging brow and the fact that the eyelid skin is much thinner than the surrounding facial skin. Below I am talking about exaggerated dark circles under the eyes that cause people to be unhappy with their appearance.

Causes of Dark Circles under the Eyes

Thin Eyelid Skin

The eyelid skin is the thinnest in the body and many people with dark circles under the eyes have extremely thin skin on their eyelids and around the eyes. This thin skin is an inherited trait. The dark circles under the eyes are caused by the fact that the purple color of the underlying eyelid muscle shows through the thin skin and creates a bluish or purple color. The color is darkest near the nose and on the lower eyelid near the nose.

Treatment of dark circles under the eyes caused by thin skin is very difficult because it is very difficult to make your inherited skin thicker. Cover up make up like Jayne Iredale Eye Cover, Dermablend, and Covermark are very helpful and my first recommendation. Frequent microdermabrasion and Retin A cream over a long period of time will build new collagen in the dermis will thicken the skin and provide some improvement.

There are new lasers on the horizon which are very effective at stimulating new growth of collagen in the dermis and these new technologies may prove very beneficial. Be sure to sign up for my free newsletter to be informed when these new technologies are available.

The Arcus Deformity discussed below creates a very severe dark circle in people with thin eyelid skin and correction of the Arcus deformity with Arcus release and fat grafting can be very helpful treatment for dark circles under the eye in these individuals.

Prominent Eyelid Blood vessels and Veins

Everyone has veins and blood vessels called capillaries in their eyelid skin. In many people however the veins are very prominent and the blood vessels add to the dark color of the eyelid.

To diagnose this cause of dark circles look in a mirror with bright light on your face and gently pull the skin of the lower eyelid tight. You will see many tiny branching red and blue lines which represent blood vessels.

You need blood vessels and veins to keep your eyelid healthy and alive. However when there is an abundance of smaller vessels which create a bluish or purplish hue to the lower eyelid some new IPL (Intense Pulsed Light) or laser therapies can be used to treat dark circles under the eyes in people with an excess of small capillaries and blood vessels. The very large veins cannot be treated.

Laser blood vessel treatment is a serious and potentially dangerous treatment for dark circles under the eyes and must be performed by a physician who is experienced in the use of lasers and IPL. Most importantly the eye must be protected by placing a shield over the eye during treatment so that the laser or IPL light cannot hit the eye. The laser and IPL light can damage the retina and destroy vision if the beams hit the unprotected eye.

Pigmentation of the Eyelids

Hyper pigmentation, too much pigment in the skin of the eyelid is a very common cause of dark circles under the eyes and dark eyelid skin. Treatment of dark circles under the eyes caused by hyper pigmentation is very effective, but the pigment frequently returns after sun exposure.

Hyper pigmentation of the lower eyelids occurs because of sun exposure and prevention with sun block, sun glasses, and a hat are the most important first treatment for this type of dark circles under the eyes.

The treatment of hyper pigmentation begins with bleaching creams such as a combination of Retin A and 4% Hydroquinone, Obagi Blender 5, Epiquin or other prescription bleaching cream combined with microdermabrasion.

After the above treatments have lessened the pigmentation causing the dark circles under the eyes, if necessary I proceed to IPL (Intense Pulsed Light) treatments. These treatments do effectively remove pigment causing the dark circle but again experience and eye protection are very necessary to prevent eye injury.

Hollow Eyes

Many people have a deep hollow beneath the lower eyelid which creates a dark shadow beneath the eyelid which people call dark circles under the eyes.

This deep hollow beneath the lower eyelid is caused by an inherited deficiency of fat and or bone and treatment of this type of dark circle under the eye requires surgery.

The hollow eye occurs more commonly in people from Central Asia and the Middle East but it certainly occurs in all races and from people in all regions of the world.

To treat dark circles under the eyes in people who have hollow eyes I do a laser procedure called an Arcus Marginalis release and fat grafting. The Arcus Marginalis is a structure which tethers the lower eyelid to the bone and creates a dark circle when the eyelid skin above the dark circle falls over the dark circle creating a shadow. Releasing the Arcus Marginalis releases the eyelid skin and eliminates the crease or dark circle.

I then transplant fat to fill the hollow in the bone and plump the dark circle and correct the hollow eye appearance.

Usually, to treat the dark circle under the eyes caused by the hollow eye I have to take fat from around the belly button on the abdomen to have enough fat to adequately fill the hollow eye deformity. The incision to remove the fat is well hidden down inside the belly button and is usually not visible.

Treatment of dark circles under the eyes caused by the hollow eye usually takes me 45 minutes to an hour, can be done with you asleep or awake, and recovery is usually 10 days. Patients do not complain of pain afterwards. The main recovery is waiting for bruising to go away and blurred vision from eye ointment that I have you use for the first week or two. Most importantly after this treatment you need to be calm, rest and not exert yourself. Working out or heavy lifting can raise your blood pressure and cause bleeding. Although you will be up and around the first few days with sunglasses to cover your bruising, I do not want you to exercise or lift heavy objects for at least 2 weeks.

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 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.

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 eyelid close to the bone of the eye socket while the rest of the lower eyelid 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. You can see this by closing one eye and gently pressing on the closed eye. With your other eye you will see the bulging of the fat against the closed lower eyelid on the other side.

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 eyes.

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 Arcus Deformity is the true dark circle under the eye and I use the term Arcus Deformity to differentiate it from the Tear Trough Deformity which is different. The Tear Trough Deformity starts near the corner of the eye in the same location as the Arcus Deformity but the Tear Trough Deformity runs down into the cheek rather than up toward the outside corner of the eye.

The Tear Trough Deformity is a sign of advanced facial aging and is caused by the sagging or descent of the cheek into the middle of the face which occurs with facial aging in your 50’s and 60’s. Tears run down the cheek and out the side of the face through the Tear Trough instead of straight down the cheek as they do in a child.

By contrast the Arcus Deformity occurs in much younger patients including children. Most people seeking treatment for dark circles under the eyes in my plastic surgery practice are in their 20’s and 30’s. Doctors often misdiagnose the Arcus Deformity as the Tear Trough Deformity which is a major problem if a Tear Trough Implant is used to treat the dark circle. The Tear Trough Implant is designed to plump or correct the depression in the cheek out toward the side of the face, and in my experience the Tear Trough Implant cannot adequately correct the dark circle under the eye where it is deepest, near the corner of the lower eyelid near the nose.

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 a very specific treatment for dark circles under the eyes called the transconjunctival blepharoplasty with Arcus release and fat grafting. This treatment is done through a tiny 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. I also use the laser to make this incision.

The benefits of the laser transconjunctival incision are:

1. No visible scar or incision on the outside of the eyelid
2. 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
3. Less bleeding during surgery
4. Less bruising after surgery
5. Quicker recovery

My results following treatment of dark circles under the eyes with the laser transconjunctival blepharoplasty with Arcus Marginalis release and fat grafting have been very successful. Most patients have recovered within a week and many who do not bruise are comfortable being seen with make up after 5 days.

Summary- Treatment of Dark Circles under the Eyes

To summarize, effective treatment of dark circles under the eyes requires that you correct the problem that is causing the dark circle under the eye. To accomplish this you must understand what type of dark circle under the eye you have and what is causing it. The following is a summary table:

Treatment of dark circles under the eyes is possible; the key is understanding the underlying cause of your dark circles. With proper diagnosis and treatment of dark circles under the eyes caused by the Arcus deformity beautiful results can be achieved with the transconjunctival Arcus release and fat grafting.

For more information on dark circles under the eyes contact me and feel free to send me photos of your eyes and I will tell you what I see after reviewing them.

Be sure to sign up for my free email newsletter as I often write about dark circles under the eyes and other topics on facial rejuvenation. I suggest you read my book Save Your Face which explains facial and eyelid aging and how to reverse and treat facial aging changes.

Dr Brooke R. Seckel

Concord, Massachusetts

Boston, Massachusetts

978-369-4499

Effective treatment for removal of dark circles under the eyes must be directed at the underlying cause of the dark circles. Millions of people complain of dark circles under the eyes but the underlying cause of the dark circles varies greatly. Treatments for dark circles that do not correct the underlying cause of the dark circle do not work. There is an incredible array of treatments for dark circles including cucumber slices, tea bags, vanishing creams, bleaching creams, lasers, surgery, more sleep, avoid TV and computer, drink 2 liters of water a day etc, yet few of these regimens seem to be directed at the underlying cause of the dark circles under the eyes.

To better understand the treatment of dark circles under the eyes I will discuss the various types of dark circles under the eyes that I encounter in my plastic surgery practice and my understanding of the cause of the dark circles, and what I feel is the most effective treatment to remove the dark circles under the eyes.

Understand that the eyelid skin appears darker than the surrounding facial skin in all people-this is the normal condition and is caused by shadows created by the overhanging brow and the fact that the eyelid skin is much thinner than the surrounding facial skin. Below I am talking about exaggerated dark circles under the eyes that cause people to be unhappy with their appearance.

Causes of Dark Circles under the Eyes

Thin Eyelid Skin

The eyelid skin is the thinnest in the body and many people with dark circles under the eyes have extremely thin skin on their eyelids and around the eyes. This thin skin is an inherited trait. The dark circles under the eyes are caused by the fact that the purple color of the underlying eyelid muscle shows through the thin skin and creates a bluish or purple color. The color is darkest near the nose and on the lower eyelid near the nose.

Treatment of dark circles under the eyes caused by thin skin is very difficult because it is very difficult to make your inherited skin thicker. Cover up make up like Jayne Iredale Eye Cover, Dermablend, and Covermark are very helpful and my first recommendation. Frequent microdermabrasion and Retin A cream over a long period of time will build new collagen in the dermis will thicken the skin and provide some improvement.

There are new lasers on the horizon which are very effective at stimulating new growth of collagen in the dermis and these new technologies may prove very beneficial. Be sure to sign up for my free newsletter to be informed when these new technologies are available.

The Arcus Deformity discussed below creates a very severe dark circle in people with thin eyelid skin and correction of the Arcus deformity with Arcus release and fat grafting can be very helpful treatment for dark circles under the eye in these individuals.

Prominent Eyelid Blood vessels and Veins

Everyone has veins and blood vessels called capillaries in their eyelid skin. In many people however the veins are very prominent and the blood vessels add to the dark color of the eyelid.

To diagnose this cause of dark circles look in a mirror with bright light on your face and gently pull the skin of the lower eyelid tight. You will see many tiny branching red and blue lines which represent blood vessels.

You need blood vessels and veins to keep your eyelid healthy and alive. However when there is an abundance of smaller vessels which create a bluish or purplish hue to the lower eyelid some new IPL (Intense Pulsed Light) or laser therapies can be used to treat dark circles under the eyes in people with an excess of small capillaries and blood vessels. The very large veins cannot be treated.

Laser blood vessel treatment is a serious and potentially dangerous treatment for dark circles under the eyes and must be performed by a physician who is experienced in the use of lasers and IPL. Most importantly the eye must be protected by placing a shield over the eye during treatment so that the laser or IPL light cannot hit the eye. The laser and IPL light can damage the retina and destroy vision if the beams hit the unprotected eye.

Pigmentation of the Eyelids

Hyper pigmentation, too much pigment in the skin of the eyelid is a very common cause of dark circles under the eyes. Treatment of dark circles under the eyes caused by hyper pigmentation is very effective, but the pigment frequently returns after sun exposure.

Hyper pigmentation of the lower eyelids occurs because of sun exposure and prevention with sun block, sun glasses, and a hat are the most important first treatment for this type of dark circles under the eyes.

The treatment of hyper pigmentation begins with bleaching creams such as a combination of Retin A and 4% Hydroquinone, Obagi Blender 5, Epiquin or other prescription bleaching cream combined with microdermabrasion.

After the above treatments have lessened the pigmentation causing the dark circles under the eyes, if necessary I proceed to IPL (Intense Pulsed Light) treatments. These treatments do effectively remove pigment causing the dark circle but again experience and eye protection are very necessary to prevent eye injury.

Hollow Eyes

Many people have a deep hollow beneath the lower eyelid which creates a dark shadow beneath the eyelid which people call dark circles under the eyes.

This deep hollow beneath the lower eyelid is caused by an inherited deficiency of fat and or bone and treatment of this type of dark circle under the eye requires surgery.

The hollow eye occurs more commonly in people from Central Asia and the Middle East but it certainly occurs in all races and from people in all regions of the world.

To treat dark circles under the eyes in people who have hollow eyes I do a laser procedure called an Arcus Marginalis release and fat grafting. The Arcus Marginalis is a structure which tethers the lower eyelid to the bone and creates a dark circle when the eyelid skin above the dark circle falls over the dark circle creating a shadow. Releasing the Arcus Marginalis releases the eyelid skin and eliminates the crease or dark circle.

I then transplant fat to fill the hollow in the bone and plump the dark circle and correct the hollow eye appearance.

Usually, to treat the dark circle under the eyes caused by the hollow eye I have to take fat from around the belly button on the abdomen to have enough fat to adequately fill the hollow eye deformity. The incision to remove the fat is well hidden down inside the belly button and is usually not visible.

Treatment of dark circles under the eyes caused by the hollow eye usually takes me 45 minutes to an hour, can be done with you asleep or awake, and recovery is usually 10 days. Patients do not complain of pain afterwards. The main recovery is waiting for bruising to go away and blurred vision from eye ointment that I have you use for the first week or two. Most importantly after this treatment you need to be calm, rest and not exert yourself. Working out or heavy lifting can raise your blood pressure and cause bleeding. Although you will be up and around the first few days with sunglasses to cover your bruising, I do not want you to exercise or lift heavy objects for at least 2 weeks.

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 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.

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 eyelid close to the bone of the eye socket while the rest of the lower eyelid 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. You can see this by closing one eye and gently pressing on the closed eye. With your other eye you will see the bulging of the fat against the closed lower eyelid on the other side.

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 eyes.

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 Arcus Deformity is the true dark circle under the eye and I use the term Arcus Deformity to differentiate it from the Tear Trough Deformity which is different. The Tear Trough Deformity starts near the corner of the eye in the same location as the Arcus Deformity but the Tear Trough Deformity runs down into the cheek rather than up toward the outside corner of the eye.

The Tear Trough Deformity is a sign of advanced facial aging and is caused by the sagging or descent of the cheek into the middle of the face which occurs with facial aging in your 50’s and 60’s. Tears run down the cheek and out the side of the face through the Tear Trough instead of straight down the cheek as they do in a child.

By contrast the Arcus Deformity occurs in much younger patients including children. Most people seeking treatment for dark circles under the eyes in my plastic surgery practice are in their 20’s and 30’s. Doctors often misdiagnose the Arcus Deformity as the Tear Trough Deformity which is a major problem if a Tear Trough Implant is used to treat the dark circle. The Tear Trough Implant is designed to plump or correct the depression in the cheek out toward the side of the face, and in my experience the Tear Trough Implant cannot adequately correct the dark circle under the eye where it is deepest, near the corner of the lower eyelid near the nose.

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 a very specific treatment for dark circles under the eyes called the transconjunctival blepharoplasty with Arcus release and fat grafting. This treatment is done through a tiny 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. I also use the laser to make this incision.

The benefits of the laser transconjunctival incision are:

1. No visible scar or incision on the outside of the eyelid
2. 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
3. Less bleeding during surgery
4. Less bruising after surgery
5. Quicker recovery

My results following treatment of dark circles under the eyes with the laser transconjunctival blepharoplasty with Arcus Marginalis release and fat grafting have been very successful. Most patients have recovered within a week and many who do not bruise are comfortable being seen with make up after 5 days.

Summary- Treatment of Dark Circles under the Eyes

To summarize, effective treatment of dark circles under the eyes requires that you correct the problem that is causing the dark circle under the eye. To accomplish this you must understand what type of dark circle under the eye you have and what is causing it. The following is a summary table:

Treatment of dark circles under the eyes is possible; the key is understanding the underlying cause of your dark circles. With proper diagnosis and treatment of dark circles under the eyes caused by the Arcus deformity beautiful results can be achieved with the transconjunctival Arcus release and fat grafting.

For more information on dark circles under the eyes contact me and feel free to send me photos of your eyes and I will tell you what I see after reviewing them.

Be sure to sign up for my free email newsletter as I often write about dark circles under the eyes and other topics on facial rejuvenation. I suggest you read my book Save Your Face which explains facial and eyelid aging and how to reverse and treat facial aging changes.

Dr Brooke R. Seckel

Concord, Massachusetts