Why are bags and dark circles still there after lower lid transconjunctival bleph?

Question

I've had puffy bags under my eyes and dark circles for as long as I can remember. I had a lower lid transconjunctival bleph with conservative fat removal in July 2014. However, my eyes look the same as they did before and they're still puffy. The dark circles seem to be because of thin skin. What could I do to fix my under eye piffiness and thin skin? The bags are more apparent when I smile or laugh, but go away if I push gently on the bag. What would be the best treatment for this?

Jason Emer, MD · Answer

It doesn't appear like you have much fat on the lower lids anymore.  And the darkness is due to the blood vessels beneath, which is genetic and rarely has anything that gets rid of it completely.  My suggestion is to see a skin care expert to start you on light laser treatments (clear and brilliant or sublative) and skin care for the eyes.  Fillers in the cheeks and trough work well to help the circles and the volume.  Best, Dr. Emer.

Harold J. Kaplan, MD · Answer

Transconjunctival blepharoplasty with fat removal rarely benefits dark circles which I think you understand now. At this point the simplest solution would  be a hyaluronic acid filler (e.g. Restylane) injection.

Sirius K. Yoo, MD · Answer

Thank you for your question.  From your photos, it appears you have a negative vector meaning your bony infraorbital rim is recessed compared to the projection of your globe (eyeball).  This can make lower blepharoplasty more challenging.  You would actually do well with either a lower orbital rim implant or fillers.  this would smooth the lower lid/cheek transition which is where you are seeing the dark circles.  Seek another consultation with someone who can guide you through this if you are not satisfied with your current results.  All the best!

Mehryar (Ray) Taban, MD, FACS · Answer

There actually isn't much fat there in your case. Looking at the photos, the dark circles are from hollowness. That can be improved with filler injection, rather than surgery.

Kenneth D. Steinsapir, MD · Answer

Removing the fullness from the lower eyelid can actually make the circles worse.  For this reason, the trend for quite some time now has been to conserve the lower eyelid fat and move on its blood supply into the top of the cheek.  This is called an arcus marginalia release surgery.  Even though you just had a procedure, I recommend under eye volume in the form of the hyaluronic acid filler Restylane.  I suspect that this would have been a very reasonable alternative to lower eyelid surgery if you had been open to that option.

Why are bags and dark circles still there after lower lid transconjunctival bleph?

Answers (7)

Answer: Filler for true dark circles from hollowness.

Answer: Filler for true dark circles from hollowness.

Answer: Transconjunctival lower eyelid surgery does not cure dark circles.

Answer: Transconjunctival lower eyelid surgery does not cure dark circles.

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Everything you need to know about Eyelid Surgery

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Why are bags and dark circles still there after lower lid transconjunctival bleph?

Answers (7)

Answer: Filler for true dark circles from hollowness.

Answer: Filler for true dark circles from hollowness.

Answer: Transconjunctival lower eyelid surgery does not cure dark circles.

Answer: Transconjunctival lower eyelid surgery does not cure dark circles.

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.