8 Weeks Post Upper and Lower Blepharoplasty: Dark Circles Below Eyes

As other colleagues have stated, excessive fat removal can be one cause of hollowness and dark circles beneath your eyes. It is unclear from your photographs if this is the case, and if you look good in person, then I would relax and give the overall healing and bruise resolution process its due time.

Post-inflammatory hyperpigmentation generally occurs in scars themselves, or in areas of ongoing healing such as dermabraded or laser-resurfaced skin, but usually not in the actual lifted or tightened skin areas. Discoloration CAN occur in these regions where there has been significant bruising, as the breakdown products from hemoglobin (hemosiderin) can cause dermal "staining." This too usually resolves over time, but can take several months or longer, and is slower if you are taking vitamin supplements that include iron.

I would first give this area 4-6 months to settle and resolve, after which IF there is still a hint of hollowness and/or dark discoloration of the eyelid, chemical peel or even a slightly depigmenting peel such as phenol peel may be considered. For now, be patient. This may well simply be a transient phase of healing, as your own doctor has stated.

Of course we do not have the before photographs.  Here is the deal, the lower eyelid fat is an innocent bystander in many cases.  It becomes visible because of thinning eyelid skin and descent and loss of malar fat.  Removing too much of this fat makes the lower eyelid look deflated and hollow.  It is very important to preserve fat in the lower eyelid-less is more.  At two months out, no you are not yet fully healed.  However, we have a very good idea of where you are headed.  I would recommend letting yourself heal about 6 months before beginning a search for what to do to help your deflated lower eyelids.  Your surgeon is too invested in his surgery to say you have an issue.  After all to him, this is what surgery is supposed to accomplish.

It is a bit too early too judge as you are still healing.  Consult with your surgeon.  It may that the area under your eye will be too hollow but there are options too address that once everything heals.

Photos posted are acceptable to show your issue. These dark circles may improve over the next few months but I believe you need to be pro active in your care. Use of bleaching creams is indicated as well as IPL therapy. Discuss with your surgeon. 

  I have performed Eye Lifts, for over 20 years and from the photos, it looks like there is a bit of hemosiderin pigment staining of the lower eyelid skin along the top of the malar bone (cheek).  You said that, in person, your eyes look fine.  Does this mean that the dark circles are not visible in person?  

  I think it's a bit premature to say that you have hollowing, of the lower eyelids, especially from a set of over exposed photos.  You still have another month or so to be fully healed, historically speaking.  You should bring up the dark circles to your surgeon at your next appointment.  If it is pigment from a post surgical bruise, he/she should have some recommendations for you.

In the old days we used to try to take out as much lower eyelid fat as possible.  Now we look back and realize how this skeletonized patients.  Not only did this make them look older, but it also made it obvious they had lower eyelid surgery.

Now the goal has changed to creating a smooth transition between the lower eyelids and upper cheek, while maintaining a youthful fullness to the area.  Taking photos is an art unto itself, but it looks like you have been very hollowed under your eyes, and then there is a sharp transition to the upper cheek.  This can certainly create the appearance of dark circles under indirect lighting.  Of course with a direct flash photograph, like your first picture, the shadows are eliminated.

Trying to fix up problems after cosmetic surgery is always more challenging, but in many cases we can achieve a nice improvement.  Do your homework, and seek out an expert in this area.

Yoash R. Enzer, MD