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

Question

I’m 27 years old and had sunken eyes for years but I think they’ve been getting worse as I’ve gotten older. I’ve been looking into treatment options but I can’t really afford anything like a blepharoplasty or fat transfer. Its seems like PRF and polynucleotides are not very effective for volume loss. HA filler is an option but it is likely to migrate? Can CO2 laser be a good treatment option?

Justin Buro, MD · Answer

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.

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

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

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Everything you need to know about CO2 Laser

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