What Are These Dark Circles/marks Under Eyes After Lower Bleph? Can They Be Fixed? (photo)

Question

I used to have eye bags now I have dark circles/marks after lower trans bleph. Is this hemosiderin staining or hyperpigmentation? It seems as if its only in a certain area under both eyes. Could it be bruising underneath the skin? I am 4 months post-op so I am assuming everything should have healed by now. Also, just to note, before I had the surgery if you pulled the eye bags tight there was no dark color or discoloration so it almost seems like this happened because or the surgery.

A.J. Amadi, MD · Answer

The photo is helpful, but an in-person evaluation is more valuable. In general, there are three reasons why the skin around the eyes can be [or seem] darker:

	1. The think skin allows the darker muscle underneath to show

	2. The hollowness around the eyes can create a shadow effect that exacerbates darkness

	3. Skin pigmentation [sometimes from blood products from bruising]

	 

	If it is blood product pigmentation, it could last months to improve.

	Depending on which of the above is the issue, different modalities may be helpful [time, fillers, laser resurfacing, etc].

	

	If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website.

John Kang, MD · Answer

Hi
I think if I knew your approximate age, whether your surgeon took trans-cutaneous vs trans-conjunctival approach, and finally a picture of your eyes prior to surgery, I can probably advise you better
But if I were to take a stab at your situation, you are relatively young and thin faced with early fat bag formation and took a pre-emptive approach to this first significant sign of aging..which I am a huge proponent of...
I really don’t see any issues with the surgery you have received... but I always emphasize to my patients the importance of taking an individualized approach and in your case, I would have sparingly remove the fat only, through trans-conjunctival approach and leave the rest of your anatomy completely untouched to avoid any appearance of surgerized look... I would have also discussed with you that  removing the fat bag would potentially “un-mask” the tear trough partly made more prominent by the fact that your nasal-lower eyelid bony junction is more anterior to the eyes...
The solution would be to try Restylene over the darkened and hollowed area... if this looks good, ultimately you will benefit with fat grafting to the area both deep and superficial to the muscle using micro technique which should restore the “cushion” or “glide zone” between the different layers of the eyelid, and hopefully improvement of the darkened area you are experiencing.   Good Luck!

Evan Ransom, MD, FACS · Answer

Without seeing you in person, it's difficult to say. However, if you had a transconjunctival approach with fat removal, it is possible that the dark circles are due to hollowness after the fat removal. The darker vasculature and muscles can "show through" the thin lower eyelid skin. In rare cases, patients with vary thin or pale skin can hve residual staining from blood products (bruising). This should be resolving by 4 months. Lastly, hyperpigmentation is possible but would be much more common in patients with darker complexion. The treatment for each of these issues will be, naturally, different. Best of luck moving forward!

Kenneth D. Steinsapir, MD · Answer

However this lower eyelid fullness has been removed surgically. In doing this, it is common to make the lower eyelid hollow. This hollowness reveals itself as a lower eyelid dark circle. The most effective treatment for this is carefully performed lower eyelid fillers with Restylane. It is possible that instead of lower eyelid surgery, you could simply have had lower eyelid fillers as an alternative to surgery.

Amiya Prasad, MD - Account Suspended · Answer

Dark circles under the eyes are a combination of ethnic pigmentation, skin thickness, vascularity, and other factors such as allergies. After eyelid surgery, there can be some temporary darkening of the skin particularly in people who tan easily. In my practice in New York, I advise my patients after blepharoplasty to wear an under eye cream with sunblock and typically the skin color returns to it's normal pigmentation. I even developed a medical-grade skin care line dedicated to helping my patients maintain their skin after surgery.

Yoash R. Enzer, MD, FACS - Account Suspended · Answer

We used to think dark circles were due to pigment.  However now we know that in most (but not all) patients these are due to shadows created by the hollow between the lower eyelid and upper cheek (nasojugal fold or tear trough).  The fact that you noticed the dark circles were not present when you stretched the lid goes along with my thought this is probably a nasojugal fold and not true hyperpigmentation.  You can take a flash photo of yourself, and if the "dark circles" are gone, you know it is from shadowing.  I try to have this discussion with the patient before surgery, otherwise it can lead to feelings of disappointment afterwards (as you are now expressing).

	What can you do now?  The most common solution is hyaluronic acid fillers to the hollow area.  There are good surgical solutions too.

	Finally, if this is true pigmentation, or just seeing the reddish muscle through very thin skin, there are some treatment options for that as well.  I suggest you sit down with your surgeon to discuss these issues.

	 

	Good Luck,

	Yoash R. Enzer, MD

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