Dr. Buckingham’s Q&A

Margie,

Thanks for your question regarding blepharoplasty under local.  The piece of information I don’t have however is are you interested in doing you upper or lower eyelids?  I’ll just answer both.  An upper eyelid blepharoplasty can easily be done under local anesthesia and we almost always do it that way.  About half of patients also choose to take a little relaxation pill also.  It is the patients choice.  Lower eyelid blepharoplasty can be done under local, but we usually do not.  Because we usually use an internal incision for our lower eyelid procedures and because the lower eyelid almost always requires some kind of volume augmentation for the orbital rim/upper cheek, it is much better tolerated under IV sedation and local anesthesia.

Ed Buckingham

Margie,

Dark circles under the eyes can have multiple causes and so a consultation is essential.  Circles can be caused by skin discoloration from venous congestions usually due to allergy or pigmentation.  Usually however dark circles are caused by shadowing from a fatty pocket that has protruded forward, from loss of cheek volume over the superior cheek or more commonly a combination of both.

The treatment for dark circled related to skin discoloration is targeted at the cause.  More commonly the treatment is to take care of the shadowing.  In younger patients the treatment may consist of filling the hollowing of the upper cheek with a filler such as Restylane.  This is a simple office procedure that takes 30 minutes and usually lasts 9-12 months.  In more significant cases cause is corrected by blepharoplasty and/or fat transfer.  Usually there is a slight puffiness in the fat pads of the lower eyelids.  This fat is removed and tightened by performing an incision inside the eyelid (transconjunctival).  A fat transfer is performed by harvesting fat from the lower body through a tiny incision and then placing it into the face through tiny punctures.  This procedure builds the cheek up into the natural position of youth and hides the lower eyelid shadowing.

It is difficult to describe in words how effective these treatments are.  Photos do them much more justice.  Please take some time to look at our site, especially the before and after photos.  I believe you will have a much better understanding.

Ed Buckingham