What can be done to help dark under eye circles after a Lower Bleph? (photos)

I just answered a question about dark circles and this is a great example how suggestions vary from patient to patient.  That is why many physician answers always state that the suggestions will vary based on the patient, skin type and examination.So you had a lower blepharoplasty, and still have circles, the reason for that is the cause of the tired looking eyes is twofold- one is the excess fat herniating from around the eye and the second is a loss of cheek fat under the eye in the 'tear trough' area.The lower eyelid surgery addressed one of the issues, which is the excess fat around the eye, you now need a filler at the top of the cheek/tear trough area to increase volume under the eye/tear trough area, this will make a dramatic difference in the appearance. Once again, the type of added filler varies depending on what you are looking for, so a less permanent but quicker HA filler such as Belotero, vs more permanent fat transfer would be your option. Another suggestion for you to consider would be to have some kind of skin resurfacing procedure to freshen the lower eyelid skin. 

Dark circles can be from a number of different things, but most commonly its from a bump of fat in the lower lid casting a shadow, thinning of skin and soft tissue over the orbital rim, cheek descent, or color within the lid skin.  Based on your pictures, it looks to be primarily about the residual skin color (I also assume most of the other issues were adequately addressed with the surgery).  Pigment in the lower lid is common, but difficult to correct.  My practice is to start patients on directed, physician grade topicals specifically designed for eye skin.  That might help, but in truth preps your skin for some form of resurfacing.  Medium depth chemical peels (Jessners/35%TCA) are good for color and moderately helpful for fine lines and wrinkles, or conventional erbium laser resurfacing present as a more aggressive option with greater results.  I have not found fractionated resurfacing to be valuable for color issues.