Dark Eye Circles and Eye Bags Removal
Dark eye circles and eye bags contribute to a tired, aged and sad appearance. These conditions bother a lot of people. Optimal treatment of these two conditions can often be done in combination or individually. They can be seen in a younger individual due to genetic factors or become more prominent as we start aging.
How do dark eye circles form?
Various factors lead to the formation of dark eye circles.
The eyelid skin is the thinnest in our entire body, thus allowing features under the skin to be easily visible. Under this thin layer of skin, we have the orbicularis oculi muscle and a robust vascular network. These partly contribute to a darkened appearance of the skin. Staining from haemoglobin breakdown into haemosiderin and biliverdin also contributes to the formation of dark eye circles.
In the Asian population, the bony structure is less prominent which can lead to a shadow effect. This gradually worse with aging as the bony structure gets thinner as it is being resorbed.
Furthermore, as we age, the ligaments around the lower eyelids (orbicularis retaining ligament and malar ligament) become inflexible and causes tear trough to form. Together with the loss of cheek volume and it's descend, it accentuates the appearance of dark eye circles.
With aging, 1-1.5% of collagen is being lost each year. This cause the skin to thin out and become less elastic, which is also a contributing factor.
Treatment of Dark Eye Circles
The first step is to get an accurate assessment of the causes of the dark eye circles. Most dark eye circles are multifactorial in nature and would need various approaches to manage each precipitating factor.
A spectrum of treatment is possible from non-invasive options like camouflage and concealers, topical skin care products and lifestyle changes, minimally invasive treatments like skin boosters, fillers, collagen stimulators and laser resurfacing of the skin to more invasive surgical interventions.
Non-invasive methods of Dark Eye Circle Treatment
There are various non-invasive methods to manage dark eye circles. The easiest being what most women do daily with concealers. Concealers contain optical diffusers to aid with reflection of light, camouflaging dark eye circles.
Certain components in skin care products can be included in your regime:
Retinoids to stimulate collagen synthesis
Hydroquinone to reduce pigmentation by stabilizing melanin production
Arbutin, Kojic acid, Niacinamide to reduce pigmentation
Topical caffeine to help reduce lower eyelid oedema and pigmentation
Certain peptides that will help modulate fibroblast activity and increase type I and III collagen production within specialized dermatologically crafted skin care products
Reduce salt intake, especially at night
A combination of lymphatic periorbital massage and cold compress to help with eyelid oedema
Sun protection
A combination of oral and topical sun protection is important in the prevention of further photodamage to the skin. Topical sunblock should be applied every 6 hours if feasible.
BBL Hero (Broadband Light)
Is the gold standard machine of the intense pulsed light range. It will aid with reduction in both epidermal and dermal pigments as well as improve the skin tone and clarity of the skin.
Radiofrequency devices
There are various treatment modalities available to create a thermal effect that will stimulate collagen synthesis and tighten the overlying skin. The effects are less subtle when compared to more invasive lasers that will ablate and fractionate the skin. However, there is no downtime with radiofrequency treatments.
Fotona Starwalker laser
It is a Q-switched Nd-YAG 532/1064nm laser that will selectively target the melanin hyperpigmentation that contributes to the dark eye circles. These are more suitable for patients with lighter Fitzpatrick I to IV skin types. A combination treatment with topical therapy will effect greater changes.
Picosure laser
This is a Q-switched Alexandrite 755nm laser which has increased safety for darker Fitzpatrick skin type patients that also selectively targets the melanin hyperpigmentation that contributes to the dark eye circles. Different options will be suggested based on the assessment.
Minimally invasive procedures
Chemical peels
There are a wide range of chemical peels and depths that can improve skin textural irregularities and underlying pigmentation. With repeated treatments, chemical peels will help to resurface the skin.
Deka laser – Fractional ablative laser resurfacing
This can improve skin irregularities, skin thickness and reduce pigmentation.
Injectables – Hyaluronic fillers
This volumize the under eye region instantly by improving the volume loss and lifting the ligamentous structures around the lower eyelids.
Injectables – Biostimulators
Biostimulators stimulates the formation of collagen, which will in turn improve the volume under the eyes and aid with lifting.
Injectables - Toxin
A small dose of toxin can be used to treat hypertrophic inferior orbicularis oculi muscle. This can reduce the fullness of the muscle roll and reduce the accentuation of the lower tear trough or infraorbital hollow.
Invasive Treatments & Surgery
Morpheus8 Microneedling Radiofrequency
A combination effect microneedling and radiofrequency heat can shrink the herniated eye bag fats. At the same time, it stimulates collagen formation which improves the overall skin quality and thickness. Different depths of settings will be applied based on the assessment.
Fat Transfer
This is a good alternative to fillers and biostimulators. Fat is a natural and easily obtained from certain regions of your body, commonly the lower abdomen or inner thighs.
The fat grafts contain adipose derived stem cells which will aid with rejuvenation. Generally about 70% of these injected fat grafts will retain and survive in the injected areas. They can concurrently be used for facial fat grafting.
Lower eyelid blepharoplasty
Dark eye circles as a result of the bulge of herniated fat through weakened septum and deep tear trough from a resorbed malar bony structure is most adequately treated surgically with a lower eyelid blepharoplasty. This is often combined with fat transposition or fat grafting to improve the tear trough hollow. Eye bags must be clearly distinguished from malar bags / festoons which will not improve with lower blepharoplasty.
The goal of lower blepharoplasty is to restore a smooth lower eyelid to cheek contour.
There are two approaches to this. One approach is from within called the Transconjunctival approach and the other approach from the skin under the lower eyelashes called the Subciliary approach. Both methods have its own pros and cons and will be discussed during the consultation. Surgery can effectively remove the herniated eye bags, tighten the weakened septum, excise excess skin and orbicularis oculi muscle, smooth the tear trough hollow simultaneously.
There will be a longer downtime as compared to the other modalities. The bruising and swelling will be most apparent during the first week, over the next month it will largely settle. You will start looking more natural over the next 3 to 6 months.
Frequently Asked Questions about
Dark Eye Circle & Eye Bag Surgery
Frequently Asked Questions about Dark Eye Circle & Eye Bag Surgery
Yes. There are two approaches to remove eyebags. One is Transconjunctival approach and the other is Subciliary approach.
Transconjunctival approach
This is when the cut is on the conjunctival which is hidden within the eye. You will not have any external scars from this approach. This is ideal for patients who do not have excess skin over the lower eyelid skin.
Subciliary approach
This is when the cut is sited very lower to your lower eyelashes, following one of the natural lines that are present over the lower eyelid skin. As a result, the scar is barely visible as it will appear like one of your natural lines under your lower eyelashes. This is ideal for older patients with excess skin and will benefit from removing this excess skin to have a smoother contour to the lid/cheek junction.
The assessment is crucial as eye bags will need to be differentiated from malar mound, malar oedema and festoons. Each of them are found in different areas of the lid/cheek junction and forms as a result of changes to various anatomical structures. The treatment of each of these conditions will vary and accurate analysis is important.
Eye bags
This develops as a result of orbital fat protruding out as result of weak orbital septum or a result of aging.
Malar mound
This is formed from a collection of soft tissue bulge which is present beneath your orbital bones and the middle of your cheek. This can occur in younger age groups as well.
Malar oedema
This is an accumulation of fluid under your eyes, making you look puffy. This can often worsen in the morning. Some medical causes can worsen it, like kidney, liver problems, thyroid disease, aesthetic injections under the eyes, allergies et cetera. Sometimes it also worsens after talking a salty meal. It is usually softer and compressible.
Festoons
Are formed from accumulation of excess skin and thinned out orbital muscle which causes a bulge or cascading appearance. This bulge is also found beneath the orbital bone. These may sometimes contain fat that have herniated out (eye bags). This often forms as a result of old age, with skin laxity, poorer skin quality as well as the forces of gravity.
Eyelid surgery is generally done under local anaesthesia. Should you prefer for sedation, you would need to be fasted for about 6 hours prior to the surgery. If it is performed under local anaesthesia, you do not need to be fasted.
You should not take any medications (like anti-platelets) or herbal supplements that can cause you to bleed during surgery prior to and after surgery.
Do bring along some shades to wear after surgery.
This depends on your presenting condition and the extent of the surgery required. It generally takes less than 2 hours.
These are some of the potential side effects after lower blepharoplasty. Most of the complications are uncommon.
- Bleeding
- Bruising
- Infection
- Chemosis – swelling of the conjunctiva
- Asymmetrical appearance
- Poor wound healing / obvious scarring / scar hypertrophy or pigmentation
- Ectropion – out-turning of the lower eyelids
- Retro-orbital bleeding with possible effect on vision
There are several things that you can do to help reduce the swelling and bruising. Anti-swelling medication, analgesia and eyedrops will be provided.
Some simple measures that you can perform includes keeping your head elevated when sleeping at night, Applying cold compress to reduce swelling, taping can also help support the swelling and reduce the tension on the wound.
Simple wound care with saline washes and application of antibiotic ointment to the wound.
Avoid taking traditional Chinese medicine or other herbal supplements which have the potential to increase your risk of bleeding.
Exercise should also be avoided for 2-4 weeks following surgery.
Lower blepharoplasty can generally last for about 5 to 10 years. With continued aging, similar issues can occur again.