Unbearable under eye hollows accompanied with hyperpigmentation that keeps getting worse with age. Options? (photos)

A combination approach will give the most improvement. Fillers, lasers like Fraxel and Aerolase, and Microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Dark under eye circles can make you look tired and older than you are. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of injectable fillers, fractional laser, and RF to blend out the eyelid hollowness and tighten the skin. 
Recommended Creams: Melarase Brightening Kit
MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Hi, Thanks for sharing your query. From your pictures i could see volume loss in the under eye region which can be corrected by autologous fat transfer. It is a day care surgical procedure and many of my patient are happy with effects of it. Kindly meet a board certified cosmetic surgeon for a proper evaluation and guidance. Good luck.

Under eye hollows can be permanently corrected with surgery or temporarily camouflaged with fillers (Restylane, Belotero, Volbella).There are great non-surgical options to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eye-lift can be performed. A dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye.
Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the actual depression.
I hope this helps!

Hello..  Thank u for sharing the pictures of the problem that is bothering u in as many angles as possible..  That definitely helps in diagnosing the condition. U do have a deep seated eye globe along with the under eye hollow ness..  U will be benefited by some kind of filling in those regions.  This can accomplished by any temporary filler injections or a long lasting Nano fat fill...  The fat grafting will have an added advantage of improving the quality of skin in that region. U can consult for better examination and more information.. 

This is a common problem in many indian patients. Dark circles have two components to them- the hollowness due to lack of volume and the hyperpigmentation of the skin.
I have founf fat grafting to be a wonderful solution for both these issues. Microfat can be injected on the bone to correct the hollowness. Stem cell rich nanofat is injected into the skin to improve the color. I is a simple procedure under local anesthesia and the results for many years.
Fillers can correct the hollowness but they do not improve the skin color, and they last only a year. So they are not my first choice

Fillers do a nice job of adding volume to hollows under the eye and improve contour irregularities.  The treatment is done in the office and the results last up to a year.  See an expert injector in your area to learn more.