How do I get rid of my dark circles? (photos)

Question

Hello, I really want to get rid of my dark undereyes but I am not sure which procedure would be the best in my case. I was thinking about either doing a fat transfer or just getting a regular lower blepharoplasty. I am really not sure though since I don't necessarily have saggy skin ...what would you recommend? Thanks!

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Mats Hagstrom, MD (license on probation) · Answer

Dark circles under the eyes are challenging and there are two components that have to be assessed.

One is contour that can throw darkening shadows in certain light. The other variable is changes in skin pigmentation or actual darkness of the skin itself. This can be from the darkness of blood vessels under thin skin or actual pigment changes in the skin.

Some people have both skin pigmentation darkness and contour issues creating darkness from how light reflects and the formation of shadows.

The transition from the lower eyelid to the mid face is complex.

In an ideal youthful face the contour should be snug at the lower eyelid cheek interface followed by ample fullness in the upper mid face.

With age the opposite often happens due to weakness in the orbital septum causing the three fat pads behind the lower eyelid to bulge and lack of volume immediately below in the mid face.

Lower eyelid blepharoplasty treats the bulging fat pads and fat transfer addresses the lack of volume immediately below.  For some people the bulging sad pads is the primary problem and for others the lack of mid face volume is the primary problem and for some people they are both equal in terms of causing issues.

Volume restoration with fillers is the easiest and is often done even in cases where and lower eyelid blepharoplasty may be a more appropriate procedure because it eliminates surgery.

Fat transfer volume restoration in this area is extremely difficult to do well on a consistent basis.

The exact area or volume is needed the most has insufficient host tissue to consistently support grafted fat leaving it prone to uneven graft survival.  This can cause unintended contour problems and palpable nodules of fat necrosis.

Fillers are the ideal option for volume restoration in this area. Consider checking out the work done by David Mabrie MD in San Francisco.

His website has an impressive collection of before and after pictures showing what’s possible with just a use of fillers.

For actual skin pigmentation issues it’s worthwhile getting a formal diagnosis by dermatologist or plastic surgeons who are well-versed in the skin pigment conditions.

Skin pigmentation treatments vary in their effectiveness based on a multitude of factors the primary one is the ideology of the pigment itself.

Best,

Mats Hagstrom MD

Robert T. Buchanan, MD (retired) · Answer

What you have is an almost classic tear trough. This is best treated with either fat or a filler. It requires, however, an expert in the area. Make sure whoever you see can show you excellent results and an almost zero problem incidence.

How do I get rid of my dark circles? (photos)

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How do I get rid of my dark circles? (photos)

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