Best Dark Circles Treatment for a 20 Year Old?

I went to a reputable cosmetic surgeon for a free consultation to talk about my dark circles. I had fillers in mind. He said I needed surgery to remove excess fat, which would cost roughly $3,100.

I thought my problem was that I didn't have enough fat, but he's saying I have too much. This is hereditary (my mom has it too) and I can't stand it anymore. Can anyone back up his suggestion, or are there other options? 

Doctor Answers 5

Lower lid blepharoplasty to correct circles

It is difficult to see exactly where the problem lies without a physical examination however it does appear you have a small amount of fat protruding from the lower eyelid region. This is best removed by a transcongetival lower lid blepharoplasty. The fat is removed from inside the eyelid and no skin or muscle is taken from the area. It is as important what you take out as what you leave in. You do not want a hollow appearance under the eye. This is a hereditary condition in many patients and I have done many blepharoplastys on "moms" and then their children ten years later. Since you are only twenty years old you have plenty of time to consult with many experts and get several opinions. Fillers in the region may give you the desired effect you are looking for and do surgery further down the road. Juvederm and Restylane are the best fillers for this region. I would stay away from Radiesse I see many unhappy patients from other surgeons when this is injected in the lower eyelid region. Best regards!

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 208 reviews

Treatment for Dark Circles Under Eyes Caused by Hollows

Hi AliMarie,

I would recommend carefully placed Restylane, likely only about 0.5cc (half of a syringe) on each side. The Restylane injections in this delicate and unforgiving area should only be performed by experienced physicians.

If you are still dissatisfied with your eyelids, you can always have blepharoplasty in the future.

Now on the otherhand for your Mom......just kidding.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

A lot of things go into making your lower eyelid issues

Dear AliMarie

I would be interested to know what flavor cosmetic surgeon you saw.

Having said that, some cosmetic surgeons have the "big cutter' mentality: every thing needs to be done with the knife. You do have a tiny amount of lower eyelid fullness that is the results of orbital fat. This is what is addressed with lower eyelid surgery. A more sophisticated approach conserves this fat and moves in into the top of the cheek as a living graft. This is called an arcus marginalis release. However, your lower eyelid fullness is small and your tear trough hollow is large, so the benefit you will get from this procedure will be modest.

Filling your lower eyelid with Restylane is a non-surgical treatment that will likely help you for more than a year, perhaps two years. You need about three 1 milliliter syringes of Restylane (1.5 on each side). In my West Los Angeles office that service would cost you about what you were quoted for surgery. I suspect that in Ohio, you are likely to get that filler service for much less than the West Los Angeles price.

I think fat grafts and other permanent fillers are a big mistake for the lower eyelid.

In Ohio, I can recommend Jill Foster, M.D., without reservation. She is an oculoplastic surgeon in Columbus. She does both eyelid surgery and periocular filler treatments. Additional eye plastic surgeons in your area can be found at the website for the American Society for Ophthalmic Plastic and Reconstructive Surgery:

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

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Treatment for dark circles under the eyes

Darkening around the eyes can be due to:

  1. thinning of the skin with increasing visibility of the underlying tissues
  2. shadows created by lax tissues (like bulging of fat into the lower eyelid that creates a shadow under the bulge) or deep set eyes
  3. generalized increased pigmentation seen in dark complexioned people of Mediterranean or Middle Eastern descent
  4. localized small blotches of increased skin pigmentation - age spots- due to chronic sun exposure & aging

You can find out which category applies by the difference in the area on direct versus non direct lighting. If you shine a light perpendicular to the skin surface and the darkness goes away then it is a shadow problem (i.e. number 2).

1 is best treated with camouflage creams & sometimes surgery. 2 can be improved with surgery (removal, repositioning or adding fat). 3 can not be changed. 4 may be amenable to CO2 or Yag or Ruby or Alexandrite laser. unless it is melasma which should only be treated with skin bleaching creams.

It is hard to say without a face to face examination but from the photos it looks like you are in category 2. Therefore that surgeon's recommendation is not too far off the mark. It may be better to reposition at least some of the fat over the boney rim under the eye in order to avoid a hollowed out appearance after surgery.

Aaron Stone, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Options for lower eyelid circles

It is difficult to tell from the photos. However, the use of fillers could be considered in your condition. If you like the result , you could proceed to more long term fillers such as autologous fat.

It is likely the surgeon recommended a transconjuntival lower lid blepharoplasty in which the fat is removed from inside the eyelid with no external incision.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 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.