Understanding and Treating Dark Circles and Puffy Eyes: A Surgeon’s Perspective

As a board-certified obstetrician-gynecologist with 25 years of surgical experience, I eventually felt the need to shift my career toward a more balanced lifestyle. While obstetrics was a deeply rewarding profession, its demanding schedule made it challenging to maintain quality time with my family and explore other interests — particularly holistic medicine, meditation, and personal well-being.

This realization led me to transition solely to gynecology. However, I soon recognized that maintaining my established lifestyle without the income from obstetrics presented financial challenges. To address this, I pursued a fellowship in cosmetic surgery, which not only provided greater flexibility but also allowed me to integrate my passion for holistic health and well-being into my practice.

Specializing in Eye Rejuvenation Surgery

After completing my fellowship, I further expanded my expertise by enrolling in a specialized course at UCLA focused on eye surgery. This decision was driven by a common concern among my patients: dark circles, puffiness, and sagging skin around the eyes. These issues are not only aesthetic concerns but can also impact self-confidence and perceived wellness.

I found eye rejuvenation surgery particularly fascinating because it effectively addresses a widespread concern with a relatively simple and low-risk procedure. One of the most effective treatments for puffy eyes and drooping eyelids is blepharoplasty, a surgical technique that removes or repositions excess fat and skin around the eyes.

Lower Blepharoplasty: Treating Under-Eye Puffiness

There are two primary approaches to lower blepharoplasty:

1. Traditional Lower Blepharoplasty — This method involves making a small incision near the lower eyelid to extract excess fat. While effective, it carries the risk of scarring that, in some cases, may cause the lower eyelid to pull downward.
2. The UCLA Transconjunctival Blepharoplasty — A more advanced technique developed at UCLA, this method involves retracting the lower eyelid, making a small internal incision, and extracting the fat using a single suture to close the incision. This approach minimizes scarring, reduces complications, and significantly shortens recovery time.

After careful evaluation, I found the UCLA method to be superior — it is minimally invasive, requires less downtime, and has an excellent safety profile. While any surgical procedure carries potential risks, when performed by an experienced surgeon, complications are rare. If you are considering blepharoplasty, it is essential to discuss the benefits and risks with your surgeon to make an informed decision.

Upper Blepharoplasty: Correcting Drooping Eyelids

In addition to lower blepharoplasty, upper blepharoplasty is a highly effective procedure for addressing sagging or drooping upper eyelids, a common concern that can contribute to a tired, aged appearance and even obstruct vision in severe cases.

As an aside, I had a personal reason for doing blepharoplasty. While doing breast augmentation surgery, I began to have difficulty seeing the necessary area when tilting my head due to my upper eyelid drooping. This obstructed my vision.

Upper eyelid sagging typically results from aging, genetics, or loss of skin elasticity over time. The procedure involves:

• Removing excess skin and fat from the upper eyelid.
• Tightening the remaining skin to create a more youthful and refreshed appearance.
• Enhancing the natural contour of the eyelid to restore a more open and awake look.

Upper blepharoplasty is a relatively simple outpatient procedure with minimal downtime. The incision is carefully placed within the natural crease of the eyelid, making any scarring nearly invisible once healed. Patients typically experience improved vision (if sagging was severe) and a more vibrant, youthful aesthetic.

The following is a comprehensive review of the causes, prevention and treatment of dark circles, droopy eyelids, and puffy eyes.

1. What causes dark circles under the eyes?

Dark circles can come from many things, like:

• Genetics: Some people have thinner skin under their eyes, making blood vessels show more.
• Lack of Sleep: Not getting enough sleep makes skin look dull and can cause fluid buildup.
• Aging: As we get older, our skin loses collagen and gets thinner, making blood vessels more visible.
• Dehydration: Not drinking enough water can make the skin look dull and sunken.
• Allergies & Sinus Issues: Inflammation and congestion can cause puffiness and discoloration.
• Excessive Sun Exposure: Too much sunlight can increase melanin, darkening the skin.
• Diet & Lifestyle: Bad nutrition, smoking, and drinking alcohol can make dark circles worse.

2. How can I get rid of dark circles naturally?

There are natural ways to lighten dark circles, such as:

• Cold Compress: It reduces swelling and tightens blood vessels.
• Cucumber Slices: They hydrate and calm tired eyes.
• Tea Bags (Green or Black): The caffeine in them tightens blood vessels and reduces puffiness.
• Aloe Vera Gel: It hydrates and soothes inflammation.
• Almond Oil & Vitamin E: They nourish and brighten the under-eye area.
• Adequate Sleep & Hydration: These are key for reducing puffiness and discoloration.

3. Do eye creams really work for dark circles?

Yes, they can, but it depends on the cause and the cream’s ingredients. Look for:

• Retinaldehyde (a gentler form of Retinol): It boosts collagen and thickens the skin.
• Vitamin C: It brightens and reduces pigmentation.
• Caffeine: It reduces puffiness by tightening blood vessels.
• Hyaluronic Acid: It plumps the skin and reduces hollowness.
• Peptides: They strengthen and repair delicate under-eye skin.

4. What ingredients should I look for in an eye cream for dark circles?

For pigmentation-based dark circles:

• Vitamin C
• Niacinamide
• Kojic Acid
• Licorice Extract

For vascular (bluish/purple) dark circles caused by thin skin:

• Retinaldehyde
• Peptides
• Hyaluronic Acid

For puffiness-related dark circles:

• Caffeine
• Green Tea Extract
• Arnica

5. Can a lack of sleep cause dark circles?

Yes! Not sleeping well raises cortisol levels, widening blood vessels and making dark circles more visible. It also causes fluid retention and dull skin, making eyes look tired and puffy. Try to get 7–9 hours of quality sleep and keep your head slightly elevated to prevent fluid buildup.

6. Does diet affect dark circles under the eyes?

Absolutely! Eating a nutrient-rich diet can help reduce dark circles:

• Iron-rich foods (spinach, red meat, lentils): Prevents anemia, a common cause of dark circles.
• Vitamin C (citrus fruits, bell peppers): Boosts collagen and brightens skin.
• Omega-3 Fatty Acids (salmon, walnuts, flaxseeds): Reduces inflammation.
• Hydrating foods (cucumbers, watermelon, celery): Prevents dryness and hollow-looking eyes.
• Avoid excess salt and processed foods: They can cause water retention and puffiness.

7. Are dark circles permanent, or can they be removed?

It depends on the cause:

• Genetic dark circles: Can be improved but may never fully disappear.
• Sleep deprivation or lifestyle-related circles: Can be reversed with better habits.
• Hyperpigmentation-related dark circles: Can be treated with skincare and professional treatments.
• Aging-related circles (thin skin & volume loss): May require medical treatments like fillers.

8. What professional treatments are available for dark circles?

If home remedies and skincare aren’t enough, professional treatments include:

• Laser Therapy: Reduces pigmentation and stimulates collagen.
• Chemical Peels: Lightens dark pigmentation.
• Dermal Fillers (Hyaluronic Acid): Fills in hollow under-eyes for a refreshed look.
• Microneedling with PRP: Boosts collagen production and improves skin texture.
• Radiofrequency & Ultrasound Therapy: Tightens skin and improves circulation.

9. How can I prevent dark circles from forming?

• Get 7–9 hours of quality sleep every night.
• Use sunscreen daily to prevent pigmentation.
• Stay hydrated and follow a nutrient-rich diet.
• Use an eye cream with antioxidants (Vitamin C, Peptides).
• Avoid excessive alcohol, smoking, and salty foods.
• Manage allergies to prevent inflammation and puffiness.

10. Are there any quick fixes for dark circles before an event?

Yes! If you need an instant solution:

• Apply a cold compress for 10 minutes.
• Use an eye cream with caffeine to reduce puffiness.
• Apply a brightening concealer that matches your skin tone.
• Use a highlighter on the inner corners of the eyes to brighten the area.
• Drink plenty of water and reduce salt intake the night before.

Dark circles, droopy eyelids, and puffy bags don’t have to be a permanent problem. With the right skincare, lifestyle habits, and possibly professional treatments, you can brighten and refresh your under-eye area for a more youthful, well-rested look!

Which of these tips are you excited to try first?