| The presence of dark circles below the eyes is a common complaint often accompanied by a high degree of frustration.
Anatomical causes:
• Eyelids: In some patients, darkness below the eyes may be the result of shadows cast by bulging fat in the lower eyelids. The convexity of the bags blocks overhead light and creates an appearance of discoloration. Excessive fat can be sculpted conservatively with lower eyelid blepharoplasty. In the majority of patients, however, dark circling is related more to cheek than eyelid problems.
• Cheek:
Hollowing located just below the eyelid may be caused by inadequate bone projection with associated descent of the cheek muscles and surrounding fat pockets. As the soft tissues of the upper cheek drift downward, the outline of the rim of bone just below the eye may become partially visible. This area of concavity prevents light from properly illuminating the skin, again creating shadows.
If the depression is more than mild, a midface lift with or without placement of a synthetic implant may be indicated. Such work is best done by a facial plastic surgeon rather than an eyelid specialist.
Some patients may benefit from the injection of filler materials into these grooves (tear trough) on the upper cheek. A variety of natural and artificial fillers are available, including liposuctioned fat. Permanent synthetic fillers can be risky since overcorrections and lumpiness are difficult to correct.
Pigmentary causes: . . . |
