How Do I Get Rid Of Hemosiderin Staining Under My Eyes From A Previous Rhinoplasty?

Q: I have had quite noticeable under eye hemosiderin staining since a rhinoplasty nearly 20 years ago. I’ve had several laser treatments over the years and am currently applying a hydroquinone cream. Nothing has ever truly worked, but I still hold out hope. Any suggestions would be greatly appreciated.

A:  Hemosiderin staining represents the deposition of residual iron oxide pigments from the breakdown of the hemoglobin molecule. While most hemosiderin staining problems resolve on their own, they do so within months due to macrophage activity. Once this problem exists beyond 6 to 12 months after surgery, the body is telling one that it will not remove it on its own.  It is faur to say after 20 years that your hemosiderin staining is fixed into the tissues.

This is a difficult problem and I think the chances of any treatment’s success is very unlikely. Certainly, no topical cream is going to work. Iron pigment in the subcutaneous tissue is not going to respond to any form of topical cream. Bleaching creams work on the skin for pigment, the iron oxide molecules lie much deeper.  I don’t know what type of laser treatments you have been receiving. The only type of laser treatment that makes any theoretical sense is the Q-switched laser, the type of laser used in the treatment of tattoos.  The residual iron oxide pigment must be viewed like a tattoo pigment being metallic in composition.  Like a tattoo, the age of the pigment in the tissues shouldn’t matter. No other type of laser or pulsed light therapy (i.e., IPL)  will work. A vascular laser will also not work since its focused light is for the oxygenated red hemoglobin, not the rusty brown color of hemosiderin.

Dr. Barry Eppley

Indianapolis, Indiana