What would be the best treatment option for me to rejuvenate my under eye area? (Photos)

Question

I've consulted with various professionals, and I've heard everything from under eye filler, PRP injections, to the wire lift procedure so I'm curious to hear other opinions. The hollowing is my main concern and the shadowing. Thank you!

Hung William Song, MD · Answer

Hi this is a very common issue that I see in my practice. I do not like to put fillers under the eyes because they are unpredictable. Even products like Belotero can give you prolonged swelling and a bluish tinge called the Tyndall effect. The skin in this area is very thin so the light reflects off the filler making it look blue. My preferred treatment for the under eye area is an autologous fat transfer. Your fat is perfectly matched for your skin so you don't have to worry about the discoloration. In fact, because there are stem cells in your fat, you will get collagen stimulation which actually improves the pigment. The trick with fat is to make sure it is properly processed so that you don't get lumps. Fat is a nice long term solution and works best when injected over 2 to 3 sessions so that it is not overdone. 
PRP can help over time. It is not very long lasting so you will need to have 2 to 3 treatments to start and then maintain with a treatment every 4 to 6 months. PRF is a thicker preparation of PRP which can give you a little bit of volume and may last longer. Combining PRP with a very small amount of fillers (Vampire Facelift) is another option. The bottom line is that the Under eye area is very delicate. The most important factor in getting great results and avoiding disasters is to find someone who is very skilled and experienced at injecting this area.

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. 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 eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) 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, lasers, microneedling/PRP, cosmelan peels, 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. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Nima Shemirani, MD · Answer

Hi @misstanya15! Tear trough fillers and PRP injections are two great options. PRP is highly effective for restoring sunken eyes. The procedure is simply quick. Two vials of blood will be collected from the patient and placed into a centrifuge. The centrifuge spins and separates the platelets from the rest of the blood components. The plasma contains the valuable collagen and growth factors from the rest of the blood's components. The plasma is then drawn up into a syringe and injected in the tear trough area. I typically recommend anywhere from 3-6 sessions.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. You may benefit from a combination treatment of dermal fillers and a skin rejuvenation treatment using a laser or RF microneedling to rejuvenate your under-eye area. Hyaluronic acid dermal fillers can diminish shadowing by filling in hollow areas and creating a smooth transition between the lower eyelid and the upper cheek area. In my office, we use a micro-cannula to inject this area, which minimizes bruising and swelling and ensures the smoothest outcome. 
In addition to filler, you can improve the skin’s texture and tone with a laser or RF microneedling treatment that stimulates collagen production to refresh the skin from the inside out. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to determine the best course of action to help you achieve your aesthetic goals.

Julia Spears, MD · Answer

Hello! A combination of filler and under-eye chemical peels would be great for you! The filler will help fill in the hollowness and the chemical peel will help rejuvenate the under the eye to give you a more even tone and gives you a more youthful look! 
Best of luck!
Dr. Julia Spears MD

Eric M. Joseph, MD · Answer

You may be a candidate for under eye filler to smooth the transition from your fat pads to your cheeks. The other option to consider is transconjunctival blepharoplasty. This involves an incision on the inside of the eye lid, and surgical removal of the protruding fat pads. PRP may be a complete waste of time and money, in my opinion. Hope this helps! Dr Joseph

Harold J. Kaplan, MD · Answer

Hello Tanya.  You are an excellent candidate for Restylane injections under the eyes (see link).  If volume replacement is your concern then Dermal fillers like Restylane are the quickest, easiest and most affordable way to remedy the concern.  With your age and anatomy, we would not suggest surgery, PRP is extremely short lived (1 month or less) and a thread (wire lift?) procedure is not going to help with volume.  Find an injector near you skilled in tear trough injections by looking at before and after photos of under eye injections on their website or social media.  Best of luck.

Nelson Lee Novick, MD · Answer

Expensive PRP when used for aesthetic purposes is backed far more by marketing hype than hard science. Threadlifts, another relatively expensive option, which I gave up performing years ago, does not last as long as promised and is fraught with many potential complications, such as nodules, divots, infection, spitting out of stitches, etc., and, unfortunately, its results anyway do not last much longer than fillers. Since the upper cheek region acts as a major support for the under-eye area, when there is volume deficit in that area not only do the cheeks suffer, but the under-eyes, do as well, with the formation of tear troughs and bags, etc. The use of an appropriate robust, natural HA filler injected properly by an experienced injector can not only enhance a more feminine oval face shape, but can significantly improve the under-eyes, as well. Make sure that you are consulting with board certified cosmetic dermatologists. Best of luck.

Nissan Pilest, MD · Answer

Hi,

Thank you for your question. Based upon the photo's you presented, there is hollowness that can be filled with a very light filler. We have a very special technique we use that just makes that hollow look more flush with the cheek. This is a very quick and easy procedure and the results are immediate.

I hope this helps.

Best,

Nissan Pilest, M.D.

Geeta Yadav, MD · Answer

Hi there! As you age, it’s inevitable to experience facial volume loss. Dermal fillers, specifically hyaluronic acid (HA) fillers like Restylane and Juvéderm, are considered a safe and effective option for adding volume to the midface, including the undereye area. Results from filler are immediate and last roughly six months to a few years, depending on the type of filler you’re treated with. Other smoothing treatments, like chemical peels, can help reduce dark circles in this area as well. Just be sure to book a consultation with an experienced provider who can determine the best treatment plan for your concerns. Hope this helps!

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