Infraorbital dark circles giving you the tired look can be caused by a shadow effect from either lower lid fullness ("bags") and/or skin laxity. Increased skin pigmentation can also cause the dark circles, in which topical agents such as hydroquinone and retinoic acid can be used to lighten the skin. If you have lower lid fullness or bags from pseudo fat herniation, then you can consider either surgery or a filler injection. The goal is to recreate the smooth contour of the eyelid-cheek profile by either removing the herniated fat with surgery or injecting a filler in the relative depression or valley.
Blepharoplasty is frequently performed via a transconjunctival approach avoiding external scars. Injections are usually done with a hyaluronic acid product such as Restylane or Juvederm. The procedure is done in the clinic, takes little time, and produces an immediate effect. One attraction of using these fillers is we can remove parts or all of the product if you're not happy with the result. If lower lid skin laxity is causing the dark circles, then skin resurfacing with either chemical agents or fractionated CO2 laser resurfacing can tighten the skin, smooth the skin, and thereby reduce the shadow effect. Your surgeon can help you choose the option that will best work for you.
