Dark Circle Still There After Restylane - What Now?

I had very bad under eye hollows. The hollows improved significantly after restylane treatment and made the transition between cheek and hollow smoother. However. Now the actual dark cirkce color (not shadow of the skull like before) underneath is the same or slightly worse. It's purple/brownish/reddish; cant really tell. When I move the skin the coloration moves too for the most part. Is it the muscle underneath? Veins? Combination? Pigmentation? I am considering bleach and or laser. Any recommendation welcome. Thank you.

Doctor Answers 13

Dark circles under the eye

I agree with Dr. Wallach.  This is commonly due to thin lower eye lid skin, allowing the "color" of the muscle to show through. This is a tough problem and there are no good treatments for it, as far as I know.

Santa Ana Plastic Surgeon
4.7 out of 5 stars 13 reviews

There may be a pigment issue or another residual problem

Dark circles may still appear even after treating them with Restylane because there may be a pigment issue or another residual problem. It may be that the dark circles cannot be treated with Restylane. Or, it may be that the Restylane was not injected in the right place. The best way to treat dark circles is to see an oculoplastic surgeon who specializes in injecatbles and other treatments. This type of specialist should know what is causing the dark circles in each individual patient and treat them accordingly.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 66 reviews

Dark circles under the eyes

Yes, the dark circles under the eyes are often due to the appearance of the muscle throught the thin overlying skin. Unfortunately there really is not much that can be done to correct this.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

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Restylane and dark circles

Difficult to tell the differences without before and after photos.  How long has it been since the injection?  Has it changed at all with time?

You need much more Restylane!

I have the largest practice I am aware of for treating dark circles. You say you were treated with Restylane with improvement. That is great. However as I look at your photo, it is my opinion that you need at least another 1.5 ml of undereye Restylane. Of course there are surgical alternatives but the services easily last over a year and are flexible so as your face changes, treatments can be tailored to those changes and an enzyme is available to adjust treatment if necessary.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Dark Circles Under the Eyes

Depending upon your skin type I would have you refrain from bleaching agents. Since you say the pigment and blood vessel problems move when you move your skin I can conclude reasonably that you would respond to broadband light laser. Using the photo facial in a forever young format I think would improve some of the texture as well as the color problems you’re having.  You certainly have a volume problem that has seemingly been solved with Restylane and when that wears off I would discuss with you using a more long-acting agent like Radiesse. However, if you’re happy with Restylane, stay with hyaluronic acids and we can just treat your texture with laser energies or bioactive topical agents. Topical agents have a spectrum of responses, I think the most cost effective methods are typically laser treatments as they are more impactful for most people’s budget.

Paul Vanek, MD
Cleveland Plastic Surgeon
4.8 out of 5 stars 30 reviews

Discoloration after under eye Resyltane

Sometimes, if it is a little bluish, it can be the filler material that is visible through the very thin lower eyelid skin. If that is the case, then a very small injection of dissolving material can solve the problem.

Otherwise, dark circles can be hard to treat. Some topical options include:

  • hydroquinone 4%
  • Vitamin c serums
  • Retin-A
  • Combination therapy (such as Triluma) with Retin-A or retinoids, steroid, and hydroquinone

Some laser options exist as well. Finally, medical issues such as allergies or thyroid conditions can contribute to the issue. Oral contraceptives can also add to the darkening at times.

It does look like you have a persistent groove at the lower lid/cheek junction so additional filler or a lower eyelid procedure might give additional improvement.

Best of luck

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 51 reviews

Dark under eye circles

There are many different reasons for under eye dark circles. Filling in the hollow will address the shadow but as the skin thins, the underlying tissue can create the appearance of dark circles. Also, quite often we see patients look like they have dark circles because of the filler. It is not an easy diagnosis over the web. I recommend that you go back to your original doctor and have a follow up assessment. It might just be that you need more filler. After that, I like the topicals like Vivites Revitalizing Eye Cream.

Lee Robinson, MD - RETIRED
Portland Facial Plastic Surgeon
3.5 out of 5 stars 2 reviews

Dark circles after Restylane

It would be necessary to examine you to determine the situation, please see your doctor who injected you for the most accurate diagnosis, first before you see other doctors. This may give you a more efficient result.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 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.