Under Eye Hollows/Under Eye Tear Troughs?

I have under eye circles. (To the point where I can see my veins and like a blueish purple skin) and I have the hollows under my eyes now my questions are. 1- What needs to be done in oder to straighten everything out and fix it all? ( I remember reading somewhere that I needed injections anf laser)? 2- "What I need done", would it be considered plastic surgery? and what would the pros and cons be? 3-How much would it cost? and would the outcome always come out right?

Doctor Answers 10

Avoid Restylane Injection For Dark Eyelid Circles With Thin Skin

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Thank you for your question.  The risk of Restylane injection to treat dark circles in patients like your self who have very thin lower eyelid skin and visible veins is that the Restylane will cause grayish lumps that are visible beneath the skin.  In addition in my view since Restylane injection is a temporary solution you will require repeated injections over time and repeated injections through the very delicate eyelid skin can cause scarring.

The link below describes a trans-conjunctival blepharoplasty with arcus marginalis release and fat grafting.  In my experience this is the best permanent solution to correct dark circles under the eyes caused by lack of fat and the attachment of the arcus marginalis

The eyelid is a very delicate complex important structure with many vital structures near the skin.  In my opinion procedures on the eyelids should be done by a plastic surgeon or Oculoplastic surgeon who is certified by the American Board of Plastic Surgery and who is experienced in complex eyelid surgery.

Treatment for dark circles under the eyes

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There are numerous causes for dark circles under the eyes.  While lack of sleep is certainly one of them, other common causes include:  pigmentation irregularities, sun exposure, visible blood vessels, stress, allergies, atopic dermatitis, pseudoherniation (outpouching) of fat from the eyelid, and heredity, to name a few.  Fat can cause the appearance of dark circles, which can be corrected by fat repositioning blepharoplasty.  As individuals age, skin tends to thin and the normal fat pads in the eyelids herniate from their normal positions and become more prominent.  This prominence can appear as bags under the eyes, and the shadow they cast appear as dark circles, while the thinner skin causes blood vessels to be more noticeable, contributing further to the dark hue.  Some pigment can be treated with laser and/or bleaching creams.  However, if it is too deep the treatment will not be effective.  Surgery can not correct dark circles due to every cause, but it will correct dark circles that are due to the aging process.  Some of the treatments are non-surgical in nature, and your needs can be assessed during a consult with a board certified specialist. The cost really depends on what needs to be performed to fix your issue. The outcome is something that would need to be discussed during a consult, as it is difficult to predict ahead of time. Thank you and I hope this helps. Please feel free to ask any additional questions, I would be happy to answer them for you!

Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 49 reviews

Injectable Fillers Work Well For Treating Tear Trough Derformities, Hollows, and Dark Circles Under the Eyes

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Due to age and sun-related thinning of the skin under the eyes and to a loss and downward displacement of fat under the eyes, many people past the age of 40 aesthetically suffer from the appearance of hollows, dark circles, crinkles, and tear trough deformities. Fortunately, in experienced hands, the use of injectable volumizing fillers, such as Radiesse and Perlane L,  and fillers, such as Restylane L, can address each of these problems with often extremely gratifying results.

Depending upon the individual circumstances, sometimes the upper inner cheek area (that region under the eyes that extends upward and inward toward the inner angle of the eye) needs to be reinflated with the use of a volumizing filler. Not infrequently, simply reinflating this region, from which fat is typically lost over time, rebuttresses the lower lid unit and by itself can improve the appearance and soften the tear troughs and hollows.

If additional improvement is deemed necessary, an appropriate amount of lifting filler can be layered above the volumizing agent to achieve further smoothing of crepeyness and to fill the tear trough directly. When dark circles are present, the additional of a tiny amount of calcium hydroxyl apatite volumizer (which is naturally whitish in color) can go a long way to lightening the dark circles. Naturally, only the services of a board certified aesthetic physician, and one with extensive experience in nonsurgical rejuvenation of this region, should be sought for this cosmetically demanding region.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Under Eye Hollow and Dark Circle Treatment

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The lower eyelid area has a variety of treatment options. Your plastic surgeon will help guid your decision based on several factors, most importantly your specific facial anatomy and your personal goals. Non-surgical lower eyelid options included facial filler (ex. Restylane) or laser procedures. Fat injection is another option to add volume and reduce the under eye hollow. Eyelid surgery (blepharoplasty) may be the most expensive with higher risk as compared to non-surgical options, but typically gives the most improvement. Lastly, some patients benefit from a combination treatment. Only after a comprehensive evaluation can an eyelid specialist help determine appropriate options for you. Best of luck.

Dr. Chaboki


Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Darkness and hollows under eyes

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There are many factors that can contribute to the darkened appearance under the eyes.  Without photos it is hard to give specific recommendations.  In general, loss of volume under the eyes with exposure of the boney rim around the eye can give shadows and a dark circle appearance around the eye.  Using a hyaluronic acid filler such as Restylane or Juvederm can significantly improve this hollowed appearance and give a softer more youthful appearance to the eye area.  Furthermore, skin texture changes and thinning of the skin can also lead to a darkened and bluish appearance to the skin.  Utilizing eye creams and resurfacing techniques can also improve the quality of the eyelid skin and reduce some of this discoloration.  

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Lower Eyelid circles

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Without photos it is hard to tell if your lower eyelid circles are just from dark skin and increased vascularity or fat pads. If there are fat pads then the best solution is surgery. If it is only dark skin, then a chemical peel will help. 


Dr. J 


Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Dark circles treatment

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There are two possible options:  1) under eye filler injections  vs  2) lower blepharoplasty with fat transposition where the existing "bags" are moved down to fill the hollow dark circle area.  The choice depends on ones individual anatomy and preference.  See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Filler Under Eyes

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As the aging process takes effect, volume can be lost under eyes giving you that hollow appearance.  I usually suggest 1cc of a dermal hyaluronic filler to be injected under each eye to start.  We have our patients followup within 1 month to determine if full correction was made or if additional treatment is needed.  Injectable fillers are an economical option if your looking for a smoother, younger looking appearance.

Jon E. Mendelsohn, MD
Cincinnati Facial Plastic Surgeon
4.8 out of 5 stars 128 reviews

It's all about volume

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Our thinking of how we rejuvenate the lower lid has really changed over the last decade. Older approaches would resect skin and fat- often leaving a more hollow eye that didn't look younger. Patients with significant skin excess and protruding fat may still need some element of resection but most patients need volume to the lower lid to really create a softer more youthful look. My techniques include the use of HA fillers (juvederm, restylane) but even better long term results can be obtained with fat grafting. Results from fat grafting may be a bit more expensive in the short term but can have results that last or many years. When you consult with doctors about this make sure you speak with someone who is truly proficient in these modern techniques

Benjamin C. Marcus, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 46 reviews

Tear troughs - lower eyelid blepharoplasty and fat grafting

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The best options for treating hollowing under the eyelids and deep tear troughs include:

-fat grafting (fat transplant, or fat injections) where fat is harvested from another part of your body and carefully injected to restore volume

-fat transposition blepharoplasty where fat from the lower eyelids is freed and repositioned to fill in the hollowed areas

-Cost are variable depending on which procedures you have and what method of anesthesia you choose to have

-Dr. Jamil Asaria, MD FRCSC

FACE Cosmetic Surgery, Toronto

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 139 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.