What is causing my dark circles and eye bags? Do I have procedure options to help target this area? (photos)

Question

I’m a 24 year old female who gets enough sleep and I’ve had dark circles since I was a child. My dad also has them very very prominent. My question is, is it a result of lack of fat, excess fat/puffiness or is it more of a dark pigment issue? How can I fix this? I may undergo liposuction. Would putting some of the fat under my eyes be a viable option or would this not help at all?

Kenneth D. Steinsapir, MD · Answer

Grafted fat is not benign. The fat causes scaring. It damages the delicate glide planes that make your lower eyelid and cheek work together. Once fat grafts are injected into this delicate tissue, there is no fixing it. Doctors may love this procedure but you won't. Please do not do this to yourself. Your best option is under eye filler in the form of hyaluronic acid filler. This is a fussy service. Go to someone who knows what they are doing. Treatment lasts about a year or so before you need retreatment. Properly done, the result is amazing and if you ever need adjustment, the old filler can be removed with an enzyme service called hyaluronidase. This flexibility is very powerful. Don't get talked into bad services.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. When the skin below the eyes loses elasticity and volume, it can create dark shadows and depressions in this area. Administering a small amount of hyaluronic acid dermal filler around the tear trough can reduce the appearance of hollowing and discoloration, resulting in a more awake and refreshed aesthetic. 
I recommend scheduling an in-person consultation with an experienced, board-certified injector who can conduct a physical exam and determine which formula may be right for you.

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.

Angelica Kavouni, MD, PhD, FRCS(Eng) · Answer

I would start with filler injection like hyaluronic acid to fill the teartrough, this is soft the apperance of the lower lids. It is much easier to do with smaller risks than fat transfer.

Harold J. Kaplan, MD · Answer

Hello Intellectual.  With your age and anatomy, you are a perfect candidate for dermal filler injections such as Restylane.  We prefer Restylane (see link) because it is a soft filler that does not absorb too much water.  Both of these properties means it performs very well under the eyes.

Tanya T. Khan, MD · Answer

Hello, you are beginning to see the early protrusion of fat pads within the lower eyelids. These “mounds” create a demarcation line at the bottom edge that is shadowed and appears darker. You may consider a fat-removal only lower blepharoplasty (no skin removal and performed trans conjunctivally) or perhaps a small amount of filler to the tear trough region to blend the demarcation line and have a smooth lid to cheek junction. Please visit an experienced oculoplastic surgeon for best results.

William Portuese, MD · Answer

First of all, make sure that your allergies are under good control with nasal sprays and antihistamines. Also try a low salt diet and see if that helps. If the bags are still present after you've tried the above measures, it's due to herniated fat. A lower eyelid blepharoplasty can accomplish a conservative fat removal from the inside of the lower lids. This is known as a trans-conjunctival approach with all of the incisions located completely on the inside of the eyelids.

What is causing my dark circles and eye bags? Do I have procedure options to help target this area? (photos)

Answers (7)

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