I am a Middle Eastern Descent Have Genetic that have Profound Dark Circles Under and Above Eye; Permanent Treatment Options?

    Pigmentation issues without eyelid bags cannot be resolved with eyelid surgery and is a difficult item to treat. 

Dark circles around the eyes can be reduced if not eliminated. I have dealt with some difficult cases of dark circles around the eyes in patients from the Middle Eastern countries. Depending on the age of the patient, I found that sometimes, just careful dissection of the eyelid skin without removal of any orbicular muscle can flatten the skin in this area and reduce the darkness. Further, swelling and blood under the skin in this area as a result of surgery may also provide more fullness and stretching of skin following recovery. That may also reduce darkness in this area. Nevertheless, one has to be examined by the physician in order to offer some reasonable solution.

Unfortunately, there is not much that can be done for dark pigmentation of the eyelids.  The primary goal of upper blepharoplasty is remove excess skin and a little fat causing the puffiness.  For the lower lids, the goals are just the opposite.  The primary goal on lower eyelid surgery is to remove the fat pads causing the puffiness and a little skin if needed when there is excess.