What can I do to treat my purple circles and puffy under eyes. Is Blepharoplasty something I should consider?

Doctor Answers 8

Correction of Hollow eyes with purple skin color

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Thank you for your question and photograph.  There are 2 different issues that need to different procedures

.#1 Purple eyelid color–discolor is caused by the fact that the eyelid skin is thin and the purple color of the muscle underneath is showing through and the fact that there are small blood vessels in the eyelid skin.  The small blood vessels can be treated with IPL and 1540 fractional erbium laser treatments can help thicken the skin and reduce the color.  However at best a 40% improvement is all that is possible.

#2 the deep crease beneath your lower eyelids is causing a dark circle shadow.  I correct this with a surgical procedure called and arcus release and fat grafting in which fat is directly surgically placed into this depression to plump and add volume to the upper mid face region.  Please see the link below for more detailed description.

Fillers may be used but need to be repeated and I do not like repeated injections with a needle into the lower eyelid region.  In addition some patients experience lumps and often visible gray lumps following filler injection in this region if the injection is not done properly.

If you do decide to have injection in my opinion only Restylane should be used and by all means avoid  DuoDERM which can cause visible gray lumps.

Eye rejuvenation can be easy!

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You are a great candidate for some easy interventions which will make a big difference to rejuvenate your eyes.  You actually have minimal puffiness, but the changes you are seeing are due to the much more dramatic volume loss in the tear trough and upper cheek. Restoration of the this volume in the cheek will give you back a wonderful, youthful eyelid contour. Restylane is a great product but there are other options.  I would consider volumization of your brow as well to rejuvenate the upper lid and a drop of Botox can help lift the upper lid/brow complex  as well.  These filler treatments take 20-30 minutes, generally have minimal downtime and will last around year.  The Botox lasts about 4 months on average.  Finally, a great skin care product like TNS Eye repair will help improve the texture of the lower lid skin.

Discuss with your local board certified expert injector.

Best wishes!

Michael Bowman, MD
Roanoke Facial Plastic Surgeon

There are many reasons for lower eyelid dark circles

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It is necessary to clearly define the cause of the dark circles often there is a combination of causes for a patient  to manifest dark circles. The two most common are loss of volume below the eyelid and pigmentation of the skin.If volume is the only problem then a filler such as Restylane (not Juvederm) would make a significant improvement.This injectable should be placed deep to avoid a lumpy appearance.If pigmentation is an issue then topical skin treatment with 4% hydroquinone and Elure may be helpful. Fractionated laser treatment are  sometimes also necessary to achieve an improvement.Patience is a key element. 

Joel E. Kopelman, MD, FACS
Ridgewood Oculoplastic Surgeon

Under eye circles can be treated with fillers

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The first thing that you should try are fillers such as Restylane as this is fast, easy, inexpensive and not permanent. If you are not happy with that then you can move on to other procedures but I think that you will be happy

Jo Herzog, MD
Birmingham Dermatologist
4.8 out of 5 stars 20 reviews

Eye bags

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I have used a "SOOF lift blepharoplasty" to treat patients with this problem for over 15 years. Good luck!

M. Sean Freeman, MD
Charlotte Facial Plastic Surgeon
4.7 out of 5 stars 55 reviews

Cosmetic improvement of lower lids?

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Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties. There is no one best procedure. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

Following the advice of anyone who would presume to tell you what to do based on a limited 2 dimensional  photo and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Dark circles under lower eyelids

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I would not recommend a blepharoplasty for your concerns.  In someone your age and with no significant skin or fat excess, I would simply recommend either a chemical peel or fractional CO2 laser resurfacing of the skin of the lower eyelids.  There are no scars and you should see significant improvement.

Carey Nease, MD
Chattanooga Facial Plastic Surgeon
4.1 out of 5 stars 24 reviews

You do not need surgery at this time (and perhaps for a long time).

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You could have enormous, fantastic help for the under eye area with Restylane under eye treatment.  The essential thing is to find the right injector.  Because these services may need to be adjusted, it is ideal if you can find someone close to home for this treatment.  These can be fussy treatments.  Detailed know how of eyelid and mid face anatomy is essential.  Don't let a goofball at a spa treated you just because they are wearing a white coat!  Know who your injector is.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.