Dark Circles After Lower Blepharoplasty

Question

I am of Afro-Carribean origin, fair to meduim complexion. I had Blepharoplasty for eye bags just over 7 weeks ago. The eye bags have completely disappeared, but I have been left with dark circles where the bruising was. My skin has completely changed color where the bruising was . I know it's still early, but my consultant was surprised when he saw me after 6 weeks. Am I just taking longer to heal or is this permanent?

David Shafer, MD, FACS · Answer

Maz,
 
Lingering darkness after belpharoplasty is often due to deeper bruising that is taking time to resolve.  There really is no magic to make it go away faster.  You may want to try Arnica Montana cream and massage it into the area.  If it is from bruising, then the pigments will not respond to skin lightening creams like hydroquinone.  However, if it is due to pigmentation, then treatment with hydroquinone may help - but it make take several weeks to even start seeing a difference.  Good luck.

Kenneth D. Steinsapir, MD · Answer

Dear Maz
First if a photograph is worth a thousand words, a personal consultation must be worth a million words.  However, here at Realself.com we are happy to give you our best off the cuff impressions.
I think that 7 week is more than enough time for bruising to resolve.  Hemosiderin staining which is tissue staining from the break down of blood is most unusual.  Also, lower eyelid surgery is not associated with post inflammatory hyperpigmentation except at the incision site. 
A lot of color issues are optical.  I suspect that the darkening you are seeing has to do with internal reflection of light in the skin due to the change in how your skin now lays with the lower eyelid bulges gone.  If I am right, no matter how long you wait this increased darkness will not resolve.  If the darkness resolves then I am wrong.
If I am right, I recommend that you learn to live with this change.  With every surgery, there can be unforseen consequences.  Hopefully the improvement in the lower eyelid contour more than makes up for the darkening of the lower eyelids.

Frank P. Fechner, MD · Answer

What you are describing most likely represents breakdown products of the bruising (blood) which can have a bronze to brownish color. Some of this is common at 4 to 6 weeks after a lower blepharoplasty. It may be more pronounced in people with darker skin color.
This virtually always goes away but it may take as long as 3 or 4 months. Sometimes specific laser treatments can speed up the process. Talk to your eyelid surgeon; it sounds that he has done a fine job; the skin reaction is somewhat out of his control.

William Portuese, MD · Answer

The dark circles underneath the eyelids where the surgery was performed can be a result of hemosiderin deposits from the bruising located in the lower lid. This can sometimes take upwards of six months to go away. Also, in addition, make sure any allergies are addressed with your antihistamines and cortisone nasal sprays to make sure that there is not a preexisting allergic rhinitis condition making your eyelids look puffy.

Hisham Seify, MD, PhD, FACS · Answer

It could take a little longer for all the bruising to go away. Use arnica and makeup for now. It is hard to tell you the next step without a clinical exam. IPL and genesis laser could help with some cases but this would be a last resort given your skin type.

Christopher L. Hess, MD · Answer

All of us that perform and consult on eyelid surgery are often asked about dark circles under the eyes.  First of all at 7 weeks after surgery the bruising is gone.  In addition, as my colleague as stated, hemosiderin staining in incredibly uncommon in the acute, ie surgery setting.   This is usually the result of chronic conditions. 
The two main reasons for dark lower lids are blood and light.  First, blood vessels of the lower lid can be more visualized with thinner skin and/or more engorged blood vessels. Now could the blood vessels of your lower lids be more pronounced after surgery-maybe.  The second reason is light.  When lower lids bulge the light is reflected differently than when the lids are flat giving the appearance of darkness.
I don't think hydroquinone will help. So I'm sorry to say, be patient but I think makeup may be necessary.

Kenneth R. Francis, MD, FACS · Answer

Maz,
Focus more on the improvement in your eye bags.  The dark circles are the result of bruising and inflammation, and usually take longer to subside in darker skinned individuals.  However, rest assured that the pigment will lighten over time.  Be sure to avoid ultraviolet exposure at all times, i.e. even if its winter apply sunblock, as sun exposure may worsen or prolong the darkening.  Good luck!

Brooke R. Seckel, MD, FACS (retired) · Answer

Blood in the lower eyelid skin following blepharoplasty can leave dark circles which may take 3-4 months to go away. This is particulaly true in darker skin patients.
Be sure to wear sun block and sun glasses to avoid sun exposure as sun can make the dark color worse.
Surgical injury to the eyelid skin can also cause "post inflammatory hyperpigmentation." If your doctor thinks that there is a pigmentary response to the surgery, then a combination of Retin A and 4% hydroquinone cream applied to the skin daily may also help.
If the discoloration persists after 3 months I would also try IPL treatments using the 650nm wavelength Lux Green IPL light treatments which can remove pigment and close any small veins and blood vessels.
Be sure to discuss this with your doctor.
Another possiblity that can cause dark cirlces after blepharoplast is excess fat removal which leaves a hollow which can cause a shadow. I doubt if this is the case with you, but if this does happen, fat may need to be replaced.

Marc Cohen, MD (retired) · Answer

People with pigmented skin often respond to irritation of the skin by making pigment. This is call post inflammatory hyperpigmentation. In addition the breakdown of a bruise can also darken the skin. It is very important during this time that you avoid the sun. In addition you should discuss this with your cosmetic surgeon and consider a topical cream that has 4% hydroquinone. In most cases, the pigment goes away in a few months. If not, there are stronger treatments available. These include higher strength hydroquinone, Retin-A and laser treatments.

Barry H. Dolich, MD (retired) · Answer

In my experience over 30 years it is rare,b ut when it occurs, it can take several months to subside. After 7 weeks, I like to start twice daily masssages with Triluma cream for approximately 6 weeks. This usually accelerates the resolution.

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