27 - What is the best treatment option for sunken eyes? (Photos)

Hi! Dr. Peterson here —
For sunken eyes, the main issue is volume loss. You’re correct that PRF and polynucleotides usually don’t add much volume, but if you’re a good responder, PRF/PRFM can provide some subtle volume and improve skin quality.
Fat transfer is one of my favorite options because it not only restores volume but also brings fat-derived stem cells, which can improve tissue quality long-term.
Hyaluronic acid fillers are another practical non-surgical option. When done by an experienced, board-certified dermatologist, risks like migration are minimal, and results can last 12–18 months.
CO2 laser can improve texture and fine lines, but it won’t restore volume.
A consultation with a board-certified dermatologist or dermatologic surgeon is the best way to figure out which approach is right for your eyes and anatomy.

Hello and thank you for your question. This is a common question we get in our practice and often times it can be a frustrating issue for both the patient and the provider. At 27, what often appears as “sunken eyes” is usually under-eye dark circles rather than true tear-trough hollows. These dark circles can result from several factors, including thin lower eyelid skin, pigmentation, visible blood vessels, shadowing from mild tissue loss, and even lifestyle factors such as sleep, hydration, or allergies. Because the issue is primarily skin quality and pigmentation rather than volume loss, the most effective treatments focus on improving the skin rather than adding volume.
Topical skincare is often the first and most cost-effective step. Products containing retinoids, antioxidants like vitamin C, brightening agents, and moisturizers can improve collagen, lighten pigmentation, and enhance overall skin health over time. PRF (platelet-rich fibrin) is an excellent minimally invasive option for under-eye dark circles. This tends to be more cost effectives than surgery can has been shown to restore mild volume loss.. PRF stimulates collagen production, improves skin thickness and elasticity, and can reduce shadowing, often with subtle but noticeable results after a few sessions.
RF microneedling is another effective treatment for under-eye circles. By delivering controlled heat and micro-injuries, it stimulates collagen remodeling, strengthens the delicate eyelid skin, and smooths fine lines. Combining PRF with RF microneedling can produce complementary benefits, improving both pigmentation, skin quality, and texture under the eyes.
Surgical options and dermal fillers are generally reserved for patients with true tear-trough hollows or significant volume loss. In patients with primarily dark circles, these approaches may not address the underlying cause and can sometimes worsen the appearance if misapplied.
Overall, a stepwise, minimally invasive approach, starting with topical skincare, is often the safest, most effective way to reduce under-eye dark circles, improve skin quality, and achieve natural, long-lasting results without surgery. I hope this answers your question.
Best, Justin Buro, M.D.