What Treatments Are Best for Hyperpigmentation Under Eyes Post Facelift?

Question

I am almost four months post-op and the dark areas still very visible. How can I tell if they are bruise stains or dark pigmentation? Would they be treated differently? Hydraquinone cream just irritates the area. Surgeon suggested CO2 Laser treatment. Can it make the problem worse? I've read some scary things about laser treatment side effects which can include even more hyperpigmentation. I'm very depressed. Is there a chance they will go away in a couple of months on their own?

James C. Marotta, MD · Answer

it is difficult to give you a clear answer as to what may be causing the darkness around your eyes without a picture. Sometimes bruising following a facelift can stimulate the pigment producing cells to make a bit more pigment. It would be unusual to see this with a facelift in the lower eyelids unless other procedures were involved or the facelift involved a composite lift or some kind of technique around the eye. This can be helped to resolve quicker with retin-A and hydroquinone but usually will resolve on its own. it may take even up to 8 or 9 months.

Rod J. Rohrich, MD · Answer

Early hyperpigmentation of the lower eyes is common after surgery due to the bruising from the facelift or eyelid surgery. It usually subsides in 7-10 days. If it persists one can consider using hydroquinone treatment in this area until it is gone completely.

Sam Naficy, MD, FACS · Answer

Although it is hard to tell without seeing your pictures what you are describing is possibly hemosiderin staining and will not respond to bleaching agents or CO2 laser. Use of a Q switch laser is your best bet.

Vivek Bansal, MD · Answer

I would try a new bleach cream called elure, or hydroquinone in 2% strength by La Roche. I have yet to see someone sensitive to it. Just apply a bit with a Q-tip and a thin film once a day will help. You can also consider Kojic acid 2% and evaluate that. Also, you should be using a SPF 30 or more under your eyes.

David Shafer, MD, FACS · Answer

Without before and after pictures or more clinical information or description, it is impossible to answer your question.  Dark circles under the eyes can be caused by many factors and each have different treatments.  With more information, we can give you more specific answers.

	 

	Good Luck.

Kenneth D. Steinsapir, MD · Answer

It is improbable that your dark circles are related to pigment associated in some way with your surgery. Hydroquinone or any other skin bleacher is unlikely to be of any benefit except to the people filling your prescription. You have not provide any photographs and generally a personal examination is needed to truly understand your issues. However, most dark circles of the lower eyelid have nothing to do with extra pigment and everything to how thin the lower eyelid skin is. Lining this very thin skin is a red muscle called the orbicularis oculi muscle. Light entering the skin is absorbed by this muscle so the skin above the muscle looks darker than the top of the cheek where light entering the skin is reflected back to the skin by a thick layer of yellow fat. Laser resurfacing creates a layer of scar tissue under the skin. This scar does a better job of reflecting light but this is a pretty severe punishment for this issue. The simplest approach that is also going to help any hollowness is Restylane filler in the dark circle. Please understand this treatment must be done by someone who is highly experienced and cannot just be placed, it needs to sculpted-easier said than done.

Jeffrey Epstein, MD, FACS · Answer

This doesn&rsquo;t typically happen, but there are some lasers that can be effective for this purpose and getting rid of the hyperpigmentation you are experiencing.

Philip Young, MD · Answer

Four months and hyperpigmentation, you can do intense pulse light to get some of the deeper pigmentation. Warmth and cold compresses alternating can be of some assistance.  Exercise will get your blood flow going and possibly help this situation. Other options instead of laser resurfacing include, topical lightening creams, serial chemical peels.  It depends on the level of pigmentation. If it is deeper you need to do intense pulse light or other pigment attacking lasers. For more superficial pigmentation surface treatments include chemical peels, topicals, and laser resurfacing.

	Thanks for reading, Dr Young

Rafael C. Cabrera, MD · Answer

I am almost four months post-op and the dark areas still very visible. How can I tell if they are bruise stains or dark pigmentation? Would they be treated differently? Hydraquinone cream just irritates the area. Surgeon suggested CO2 Laser treatment. Can it make the problem worse? I've read some scary things about laser treatment side effects which can include even more hyperpigmentation. I'm very depressed. Is there a chance they will go away in a couple of months on their own?

	the dark areas may be the consequence of hemosiderin (bruising), hyperpigmentation, or Tindall effect (blue hue from light reflection/refraction/absorption).  Whatever the reason, at 4 months there is still some "healing" or settling that may occur. lay off the hydroquinone if it is making matters worse. CO2 is just plain wrong. It doesn't treat hemosiderin or tindall effect and can make hyperpigmentation worse. save depression for real problems. this is just a bump in the road. at some point, peels, IPL, or other skin care tx's will be possible.

Mario J. Imola, MD, DDS · Answer

Dark circles under the eyes can be contributed by multiple factors:

	
		post-inflammatory hyperpigmentation
	
		uneven surface contour such as 'tear-trough' deformities or bulging orbital fat casting a shadow in this location.
	
		inherent dark color of the eyelid skin versus the cheek skin due to the lack of any substantial fatty layer between the skin and eyelid muscle.


	At this point 4 months following your face lift, the majority of healing will have occurred and a reasonable diagnosis regarding the cause of the dark circles should be possible.  Once the cause has been determined, then attempts at correction can be suitably chosen.  For example, if the cause is a tear trough deformity then injectable fillers or fat transfer can be tried.  If the cause is hyperpigmentation, then topical whitening agents or intense pulsed light my be of benefit.  If the cause is bulging orbital fat then perhaps a lower blepharoplasty will improve the dark circles. 

	Sincerely, Mario J. Imola

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