As time marches on our facial features change. Our most notable are the features around the eyes, nose and lips that compose what we're describing these days as the “midface.” The eyelids have several layers that contribute to a youthful and to an aging appearance of the midface. They are related to the underlying structures, most evident of which is the periorbital fat - a cushion of "filler fat" that supports and protects the eyeball itself. One of these layers - the orbital septum acts as a "dam" keeping the periorbital fat "in its place.” As we age, this "dam" weakens, allowing the fat to protrude above and below the eyelids giving you the “dark circles.” These "shadowy" areas are seen because the skin is thin over bony areas, in this case the bony orbit margins or “rims.”
Correction defies any topical application of creams, lotions or potions. They also defy surgical procedures of the past. Recently however, over the last eight years, "midface lifts" have become increasingly popular for their "almost invisible" scars around the eyelids and in the scalp (when the endoscope is used). Their design and extent varies from surgeon to surgeon but the principle remains that of elevating the bone lining (periosteum) and with it, its many ligament, muscle and fat attachments that have "drifted south" leaving you with those unwanted "dark circles" along with flat cheeks and eventually "jowls" in the 30’s and 40’s. The procedure has been described as "putting what's fallen back in its place" and has revolutionized the rejuvenation efforts in the "midface" because of its minimal bruising and excellent blending in a relatively short time.
Other procedures to help with the thinness of tissues compounding the 'dark circles' are tissue fillers and injectables of various types, from Sculptra (a poly-lactic acid derivative), to Restylane (a hyaluronic acid product). These are office procedures, which, when done with a small amount of local anesthetic, can yield immediate results with very little "down time.” There are always limits to what "fillers" can achieve but many more are becoming available with FDA approval annually and I suspect we'll have several more options in years to come.
