They say that the eyes are the window to the soul. But what if the skin around them is puffy with dark circles?

We asked Toronto-Based Dr. Andre Gantous, MD, FRCS(C), FACS, Facial Plastic Surgery/Otolaryngology and Neck Surgery, how to cosmetically deal with the most common complaints about the eye area.


"When people have a droopy eyelid, and a little bit of fat around the upper lid, upper lid blepharoplasty is the solution," says Dr. Gantous. During this procedure skin and some muscle is removed, as well as fat, in certain cases. "We may also combine this with a brow lift because it might be necessary to lift that as well," he says. This results in an eye that looks more alert, refreshed, and open. The procedure takes about an hour, or two hours if combined with a brow lift. Swelling and bruising lasts for about two weeks. "We ask the patient to keep the area clean, apply antibiotic ointment over the area, and ice it for the first 48 hours." Price range: $3,500 to $5,000, or approximately $6,000 when combined with brow lift.


"This is for people who have puffy bags under the eyes or swollen lower lids with fat protrusion," says Dr. Gantous. "An incision is made on the inside of eyelid, and we take out some of the fat or we reposition it." No skin is removed during this procedure. "It takes a little less than an hour for both eyes, and recovery is similar to the upper lid blepharoplasty." Price range: $3,500 to $5,000.


"Some patients have skin hanging loosely or folded over the lower lid area," says Dr. Gantous. "In this case, we make a cut under the eyelid, and we deal with the fat underneath, taking it out or repositioning, and then we take out excess skin." It may also be necessary to address crepey or excess skin using a laser, chemical peel or radiofrequency treatment, or a combination of these. Price range: $3,500 to $5000.


If the bags under the eyes aren't too severe, or a patient does not want to have surgery, Dr. Gantous suggests using fillers, such as Restylane or Radiesse, to treat the eye area. "We will use fillers around the periorbital area," he says. "That gives a very nice result, almost as if you had taken the fat out. We can fill around the area where fat is protruding, to give more volume and make the patient look more rested." Price range: $400 to $800.


In cases where patients prefer a non-invasive option to treat dark circles, Dr. Gantous prescribes Lumixyl cream ($120 for a three-month supply) at his clinic. The cream contains skin-brightening peptides rather than hydroquinone, and must be used in combination with sun protection. "There are many reasons people get dark circles," says Dr. Gantous. "Sometimes it's extra pigment, sometimes the quality of the skin, genetics, or perhaps a little bit of vascularity under skin. If we can't treat it with the cream, we can use a C02 or fractionated laser, or IPL." Price range: $400 to $1,500.