Best Treatment for Dark Circles and Facial Veins?

I have had very dark circles under my eyes almost all my life (not due to lifestyle factors). There is also a few blue veins that partially contribute to the problem and are even more unbearable. I am considering laser for vein removal (to remove the large veins underneath my eyes). Depending on the results, I would then consider fillers. I have attached photos. What is the best approach in this case? Thanks in advance for your advice.

Doctor Answers 2

Laser first for the blood vessel, then filler

I would get the vessel reduced first. A  long-pulsed Nd YAG laser may be best if the blood vessel is larger and blue. A pulsed dye laser is better for smaller, pink blood vessels.  Once the blood vessel is gone, fillers will improve the contour. For improved texture and mild pigment, try Renova, Lumierre and daily sun protection.

New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Fill the dark circle with hyaluronic acid filler.

Hi Kim

I deal with these issues every day.  The best treatment for the circle hands down is hyaluronic acid filler.  I prefer Restylane for this.  Once you get sufficient filler, the treatment lasts well over a year and is far more successful than surgery.  Approximately 30% of patients need some sort of an adjustment to get the service right but this is pretty easy to do with hyaluronidase, the enzyme that breaks down the product.  The vein is another matter.  This will most likely require stripping which is a time consuming surgical procedure that I do in the office though tiny nicks in the skin.  Generally I do attempt to use a laser to close these off but the success of this is about 50% with two treatments.  So advocate sclerosing these veins.  This makes me very uncomfortable.  Although there are no reported cases of visual loss, these superficial veins do communicate with the deep venous system that drains the eye.  There is a theoretical risk of getting the sclerosing agent into the eye circulation which could damage the vision.

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