PRF did not work, what else can I use to treat my under eyes? (Photos)

Question

I’m 40 and have done prf to improve my under eye area with no improvement after 4 treatments what else can I do

Brandon Kamrava, MD · Answer

It is hard to say what the convexity issue is from only this view, as you could have hollowing vs bulging of the tissue and those can both create issues while requiring very different treatments. You do appear to have excess skin of the lower eyelid, regardless though. Non surgical treatments that can improve this are improvements in skin care. Sunblock and retinol can help with overall skin health, a serum with hyaluronic acid can help rehydrate the skin and improve volume, Vitamin C can help with sun related changes, and caffeine can help with discoloration. Outside of skin care, either a chemical peel or CO2/erbium laser can tighten the skin in a non surgical option. A skin pinch lower blepharoplasty is another option. It is difficult to advice if a lower blepharoplasty with fat transposition or grafting or just fat grafting/filler alone would be helpful from the images provided. And it is always important to have proper pre-operative evaluation prior to surgical treatments to be sure your lower eye lid and eyes are safe for these surgical options.

Nelson Lee Novick, MD · Answer

The upper cheeks are a major support for the under-eyes, so when there is volume deficit, as seems to be the case her from the photos, the use of a robust HA volumizing filler, properly injected in the appropriate locations, can result in a significant improvement of infraorbital hollows and tear troughs. 
As an aside, I was not surprised by the lack of success of the PRF. The fact is that the hard science to back of the use of PRF and PRP, for that matter, lags well behind the social media buzz and marketing hype to promote these treatments. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injection expert and best of luck.

Anna Chacon, MD, FAAD · Answer

Hello!

I understand your frustration, especially after completing four PRF treatments and not seeing the improvement you were hoping for. The under-eye area can be particularly challenging to treat because several different factors can contribute to its appearance, and the right treatment depends on the underlying cause.

At 40, under-eye concerns may be related to volume loss, thin skin, pigmentation, prominent blood vessels, hollowness, or puffiness. Sometimes, more than one of these factors is present.

Here are some alternatives to consider:

Hyaluronic acid filler: If the primary concern is tear-trough hollowness or volume loss, carefully placed filler may soften the transition between the lower eyelid and cheek. However, it is not appropriate for everyone and can sometimes worsen puffiness or cause persistent swelling. The under-eye area requires an experienced injector because of its complex vascular anatomy.

Laser treatments: Certain fractional lasers can improve fine lines, crepey skin, and skin texture by stimulating collagen remodeling. Other laser options may help with pigmentation, depending on its cause.

Radiofrequency treatments: These may provide modest improvement in mild skin laxity and crepey texture by stimulating collagen production.

Lower blepharoplasty: If prominent under-eye bags or excess lower-eyelid skin are the main concern, surgery may provide a more predictable and longer-lasting improvement than injectable treatments.

Fat repositioning or fat grafting: In selected patients, a surgeon may reposition existing lower-eyelid fat or restore volume to improve hollowness and the transition between the eyelid and cheek.

Since you have already completed four PRF sessions without noticeable improvement, I would not necessarily recommend continuing the same treatment. PRF results can vary, and it may have limited effectiveness when the primary concern is structural volume loss, prominent fat pads, or significant skin laxity.

My recommendation is to determine whether your main concern is hollowness, dark circles, puffiness, or loose skin before selecting another procedure. These concerns can look similar but require very different treatments.

I would also be cautious about adding under-eye filler without a proper assessment, particularly if you have existing puffiness or fluid retention in that area. More product does not always mean a better result.

The good news is that PRF not working does not mean you are out of options. The most important thing is choosing a treatment that addresses the actual cause rather than continuing procedures that may not be suited to your concern.

Ed Robinson, MBBS · Answer

I'm sorry the PRF didn't give you the improvement you hoped for. PRF can help with skin quality, but it doesn't change the structure of the under-eye area. So if the main issue is volume loss or puffiness, it's not surprising that four sessions made little difference.
From your photos, there seems to be a combination of mild puffiness or fullness under the eyes, a visible tear trough, and some fine crepey skin and shadowing. The right treatment depends on which of these is the main problem:
- Hollowing (tear trough): A small amount of carefully placed filler can help, but only in the right person. If the main issue is puffiness or fluid, filler can make it look worse.- Under-eye fat pads (bags): These are usually best treated surgically (lower blepharoplasty). Non-surgical options tend to disappoint here.- Thin, crepey skin and fine lines: Treatments such as laser resurfacing or microneedling, plus a retinoid eye product at home, can gradually improve texture.- Dark circles: These can come from pigment, visible blood vessels or shadowing, and each needs a different approach.
It's worth seeing an experienced doctor in person for a proper assessment, ideally someone who will tell you honestly when a treatment won't help. Good lighting and a few photos taken from different angles also help show whether the shadow comes from hollowing or puffiness.

Michael W. Sistare, DO · Answer

Generally if someone doesn't get the volume they're looking for with PRP/PRF, I then recommend facial fat allografting. This may take more than one attempt due to the inherent uncertainty of fat viability. If patients get the volume they need from fay, but still have small contour defects in their undereye, I generally recommend tear trough filler at that point. 
Surgical options include lower bleph with fat pad transposition, or even a midface lift to resuspend the malar fat pad.

PRF did not work, what else can I use to treat my under eyes? (Photos)

Answers (5)

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