ASK DR. YAGODA

Question: Is there a way to remove dark under eye circles and bags without surgery? I’m 42 and I’ve had a blepharoplasty in the past, so I don’t want to undergo surgery again.

Answer: Your question is a common one, but the answer is a bit complicated.  I am guessing you mean that you’ve had lower lid blepharoplasty?  If so, there should be no “bags” or bulging fat left.  However, on occasion, fat may be missed in the original surgery or it may appear later in the aging process.  If fat is left behind, it typically causes a bulge under the eye at the outermost part.  However, if the bulge is in the center or middle portion of the lower lid, this may be a muscle ridge.  A muscle ridge is caused by repeatedly squinting while in the sun.  The best treatment is actually prevention:  wearing sunglasses when you are outside.  If it’s too late for prevention, treatment may include Botox or Dysport to soften the area of muscular prominence caused by overuse.  Another option is judicious surgical excision. However, beware of aggressive removal techniques because they may leave you with a weakened lower eyelid muscle and difficulty in closing your eyes.

As for dark circles, the best treatment depends on the cause(s).  When the cause is genetic (especially common in people of Mediterranean descent), it may be due to pigmentation and it can be especially difficult to treat.  When the dark circles are related to allergies, nasal congestion and sinusitis, surgery of the nose and sinuses can help.  When the dark circles are present in fine, pale eyelid skin, the cause may be hemosiderindeposits (a component of blood) and non-invasive laser and light therapy may be of benefit.  While there are many options for treating dark circles and bulges under the eye, the best result will only occur with the right diagnosis.  Make sure to visit a specialist to fully evaluate your treatment options.