Several features create a fatigued appearance. Dark lower eyelids are among the most common. Darkness results from shadow and/or skin pigmentation. The first step in treatment is physical examination to determine the cause.
Position of the eye, type of skin, contour of skin, complexion, amount and position of fat around the eye, and other factors influence shadows cast upon the lower eyelid. Because eyelid skin is thin, delicate, and constantly moving and blinking for years, it easily becomes loose and develops very fine creases. The cumulative effect of small shadows inside each fine crease is darkness of the entire lower eyelid. Tightening of skin or removal of excess skin will smooth and lighten the eyelid, an office procedure. If shadow is cast beneath a bulge of fat, redistribution of the fat to reflect light (cheek lift) rather than absorb light may be recommended. Non-surgical filler is widely applied (off-label use) to soften the crease beneath a fat bulge. This non-surgical treatment may correct a tired appearance, but should be skillfully used to avoid a puffy looking face. Currently available fillers last for months or years, delaying or perhaps eliminating the need for surgery. If there is a concavity or “hollow” of the lower eyelid which casts a shadow beneath your eyes, filler may offer safe, dramatic, and long lasting correction. Alternatively, especially if cheekbones lack prominence, placement of a solid facial implant to augment this area is preferred.
If darkness of the lower eyelids is related to brown or tan pigmentation, skin lightening may be recommended. This may be accomplished with prescription bleaching formulations, chemical peel(s), and/or laser treatment.
Because every individual presents with a unique situation, office consultation is the first step of treatment. We offer non-surgical and surgical solutions and will explain your choices. Even if you choose non-surgical treatment, because of Dr. Laverson’s thorough understanding of eyelid anatomy, contouring this area is performed skillfully. Injected fillers, lower eyelid blepharoplasty surgery, or placement of implants must accomplish the desired changes, including lifting sagging skin around the eyes, filling hollows, adding the correct volume in the correct area(s), and softening and smoothing wrinkles and creases. Dr. Laverson will also explain and consider additional aesthetic elements such as eyelid shape and orientation.