I am 67 years old and have had darker bags under my eyes for about more years than I can remember. I have heard it is due to fatty tissue. I want to have eye surgery, but I am very concerned that the skin will stay dark. Is this a problem with blepharoplasty?

Dark skin of the lower eyelid can be due to a variety of conditions. Allergies and thyroid disorders can create this appearance and correction of these medical conditions may improve the appearance of dark skin of the lower eyelid. Another potential cause of dark skin is pigmentation within the skin of the lower eyelid. A chemical peel with 88 percent phenol or a fractionated CO2 laser procedure may improve this pigmentation. Bleaching creams may also improve the pigmentation of the skin. Another potential cause is superficial blood vessels just beneath the lower eyelid skin. Finally, another potential cause of dark circles of the lower eyelid is protrusion of fat juxtaposed with a hollowness (this hollowness is sometimes referred to as tear trough deformity). A lower lid blepharoplasty may improve this appearance. In this case, I would recommend a lower lid blepharoplasty with re-positioning of the lower lid fat to the hollowed regions, thus giving a more youthful contour to the lower eyelid and cheek complex. A non-surgical alternative is hyaluronic acid filler injection to the hollow region.