49 - Is there a surgery that can rid me of my deep dark circles? (Photos)

It is critical to understand that different things are causing your under eye darkness. One issue is the tear trough hollow, that is the junction between the lower eyelid and the top of the cheek. This groove is a ligament based system. It can be helped with hyaluronic acid fillers. However this type of service requires maintenance that many men are not really happy in participating in. Generally people get these services topped off once per year. After about 3 or 4 years, the old filler should be removed with enzyme and replaced with the least amount of filler that gets the job done. The other challenge with this service is that it is very technique dependent and most injectors in the marketplace really do not understand which of the fillers are best for these services, and they lack a detailed understanding of mid face//eyelid anatomy needed to perform a successful service.

You have a prominent lower eyelid which reflects a relative weakness of the projection of the orbital rim. In many eyelids, the lower eyelid fat can be released under the tear trough hollow with a surgical procedure called transconjunctival lower eyelid arcus marginalis release. In some cases, I will also recommend an orbital rim implant to augment volume along the orbital rim. Again this is a surgical approach and there is no substitute for a detailed in person assessment to determine which of these approached is right for you.

You will read about fat grafting and I can't stress enough that this approach is not reliable despite many surgeons who claim they are enthusiastic about this option. It is like having scar tissue injected in the cheeks and it will damage how the cheeks heap up and the retained volume is unpredictable leading to disappointment. I see 3 to 4 new patient consults per week where grafted fat in this area is the basis for the consultation. I strongly advise against this approach.

Finally you have another common cause of a lower eyelid dark circle in addition to the tear trough groove. You have (most of us do really) thin lower eyelid skin at overlies a red muscle. Compared to the cheek, light coming into the skin does not bounce off a layer of yellow fat but instead is partially absorbed by the underlying muscle. It contributes to this area looking relatively dark. This is really no effective treatment for this. Sure, providers will be happy to offer you all sorts of laser treatments and skin products for this but they will at best be expensive, ineffective, and at worst harm the color and texture of your eyelid skin. So please be careful about which "fixes" to choose.

There are 2 distinct issues going on with your eye appearance in opinion: 1. the dark circles 2. aging changes of your lower eyelid. I would tackle this with a cheeklift (aka midface lift) to shorten your lower eyelid bulge area and loosen the ligament that makes the transition into your cheek area so distinct. Then either before or after I would recommend a chemical or laser peel to lighten the color. Fat graft can also help with certain patients as those patients have veins under thin skin that contribute to the dark circle appearance. Best Wishes!!

You seem to be a good candidate for transconjuctival lower blepharoplasty and periorbital fat grafting. In person consultation with a board certified plastic surgeon familiar with this procedure is recommended. Good luck.