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Dark Circles Treatment

If you are reading this, you probably know that under eye dark circles are a major problem. Psychology researchers report that individuals are reluctant to invest in a friendship with people with dark under eye circles. The reason cited is that the circle is judged to be a sign of ill health and they are not sure if the person will be around to reciprocate the friendship. Intuitively, we know that the dark circles detract from a youthful, healthy look.

The dark circle area is also called the tear trough because when we cry, tears can collect in this area.

What Causes Dark Circles?

The theories on the Internet are endless. Those in the medical literature are necessarily better or more accurate. An article appeared in a 1963 issue of Eye, Ear, Nose, Throat Monthly by S.H. Sanders titled: Allergic Shiner-Significance. This article claimed a relationship between under eye dark circles and allergic rhinitis with absolutely no evidence to support the hypothesis. It has also been claimed that dark circles were caused by venous congestion without a scrap of evidence. This was probably based on a wives tale. There is absolutely no evidence to conclude that there is a bit of truth to these claims. Yet, “allergic shiners” often held out as an explanation of the dark circle.

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Authors without good evidence have also attributed under eye dark circles to “extravasation of hemoglobin,” and pigment deposits. One study based on a limited number of skin biopsies claimed that these eyelids had increased subcutaneous vascularity as the basis of the dark circle. While there are conditions associated with increased skin pigmentation, these are rare.

Before & Afters

Most Plausible Explanation Of Dark Circles

The best explanation for the basis of the under eye dark circle is that the skin of the lower eyelid is very thin. Underlying this skin is a uniform layer of the orbicularis oculi muscle. This thin muscle is red. It absorbs light that strikes the skin and passes through it. Light is absorbed by the red muscle just under the skin, and this makes this area look dark. Compare this to the adjacent skin of the cheek. This skin is supported by a thick layer of yellow fat that acts to reflect light that penetrates the skin helping to make this cheek skin lighter in appearance compared to the under eye circle skin, which appears dark. In many cases, there is also a hollow in this area and this may contribute to internal reflection causing the area to look darker. Volume above the under eye hollow area can actually shadow this area. A physical examination will help to determine the cause of volume above the hollow or tear trough area. Fullness above the tear trough area can be herniated orbital fat. We call that a “bag.” However, it can also be caused by the contour of the bony orbital rim, in which case, it would not be considered a “bag.” It is important for a surgeon to correctly identify the basis of the issue because it will determine the best dark circles treatment approach.

Under Eye Dark Circle Surgery

Traditional under eye bag treatment is lower eyelid surgery. Unfortunately, this surgery is seldom appropriate for the under eye hollow/dark circle. When there is herniated orbital fat, the fat can be transposed to provide volume in the under eye dark circle area. For the right individual, this is an excellent surgical strategy to address the dark circle.

Due to the limitations of standard lower eyelid surgery, midface surgery may be recommended as an alternative approach. Midface surgery means different things to different surgeons. For some, midface surgery entails mobilizing the cheek soft tissue from a subperiosteal plane deep to the bone covering and lifting from behind the hairline. These very aggressive surgeries gained popularity in the mid 1990s. However, surgeons have generally moved away from this type of surgeries with some exceptions. The biggest reason was persistent swelling and unsatisfactory cosmetic results despite a very big surgical effort.

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Another approach that gained popularity in the 1990’s and continues to be immensely popular is fat grafting. For many reasons, this surgery has a lot of problems. For the most part, it is a highly unforgiving surgery. Even small clumps of grafted fat can show up as a lump or bump. Unlike hyaluronic acid fillers, there is no simple way to adjust a lump from grafted fat. Much of this fat is associated with scar tissue that can’t be adjusted in a simple way. Steroid injections can result in atrophy and a dent. When you gain weight, the grafted fat gains weight. There is no simple way to remove this volume when it is causing a problem. In some cases, there is no reliable way of surgically removing the grafted fat without causing further harm.

Generally, Dr. Steinsapir advocates for the most effective, least harmful approach to your under eye issues. The hyaluronic acid fillers have revolutionized the treatment of under eye dark circles. The most important consideration is which hyaluronic acid should be chosen. Only one product has withstood the test of time and that is Restylane. Restylane is a high G prime, low tan delta filler. That means that the product stays precisely where it is placed. That is critical for filling the under eye hollow. The so-called smooth fillers have proven to be a big problem in this area. The products have a lower G prime and a higher tan delta. That set of characters means that the smooth fillers drift after being placed. Dr. Steinsapir calls them “runny.” Examples of products in this category include Juvederm, Belotero, and Restylane Silk. After an under eye treatment, these products often spread and drift into the cheek creating an area of fullness that does not look right. Why do doctors persist is choosing these runny products? It is because they have had difficulty with lumps and bumps after the placement of Restylane. Dr. Steinsapir places and sculpts this product into place using a variety of techniques he has developed to minimize the risk of these issues. He has a discerning eye for this work. Once placed, treatment is typically good for about a year before needing to be topped off. If there is ever an issue with hyaluronic acid filler, it is easily modified using an injectable enzyme hyaluronidase. This enzyme can be used to completely remove an unsatisfactory treatment or a tiny amount can be used to feather a service.

What about Dr. Steinsapir’s vertical midface lift surgery over an ePTFE rim implant for under eye circles? He routinely performs this surgery. However, he only uses this approach for fixing botched lower eyelids that have been damaged by prior midface and/or lower eyelid surgery. In those circumstances, he will recommend this comprehensive approach to repair the lower eyelid without hesitation. However, if you have not previously had surgery, it is very likely you will accomplish your goals non-surgically with under eye filler. Dr. Steinsapir is not saying that you can go to an injector and get the results that he offers. He has patients who travel from around the world for his under eye treatment. He has a unique combination of an artist’s eye and the exceptional knowledge that comes from his detailed understanding of under eye issues. He encourages you to consult with him to determine which approach is ideal for your issues. If you choose to have a filler treatment, this can be performed at the time of your consultation.

Where will your surgery be performed?

Dr. Steinsapir performs his surgery in two locations. For most patients, he performs surgery in the private, state of the art, accredited surgery center in the operating rooms that are part of his beautiful Beverly Hills Office. The other location he performs surgery is the Surgery Center at the UCLA Ronald Regan Medical Center on the UCLA Campus. Generally, this center is used for patients who want cosmetic surgery but have more significant health issues. For others, they love the affordability and convenience of the surgery center in Dr. Steinsapir’s plastic surgery center. Not every surgeon has her/his own accredited surgery center and operating room. A surgeon may pressure you to have your eyelid surgery under just local anesthetic in an unaccredited procedure room. That may not be right for you. Most patients benefit from some degree of sedation, even if brief, to make surgery comfortable. When sedation is not available, you will be more aware of the work that is being performed and the injection of local anesthetic. Most can tolerate this discomfort, but it is so much more pleasant to be properly sedated. Your comfort and safety is our foremost concern. In addition, the certification of the surgery center assures you that appropriate quality assurance standards are met in all aspects of your surgical care. Dr. Steinsapir is very proud of the quality standards met by his office and surgery center. Ask for a tour when you are in the office. There are very few centers that are as clean and modern as Dr. Steinsapir’s office and surgery center.

Dark Circles Surgery Treatment Beverly Hills & Los Angeles

Dr. Steinsapir and his staff will also discuss with you prior to surgery what you need for your recovery. This is very important. For those who are coming from out of town, they may need a night nurse for one or two nights or in some cases, a recovery facility may be recommended. For those traveling with loved one’s, in most cases, your family member can serve as your night nurse.

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"I am a nurse, and have met many surgeons, but never one that measures up to Dr Steinsapir. He is not only extremely knowledgeable and talented, but also empathetic, kind, caring, and compassionate. His entire team is top notch! He truly is an expert at what he does."

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