Genetic Hollow and Raccoon eyes (Photo)

Question

Hey there, so I wanted to ask due to genetics I unfortunately have lived with raccoon eyes, having really dark hyperpigmentation around my eyes and hollow eyes for such a long time. I really want to a permanent solution and to avoid fillers, would a certain type of laser be able to get rid of the darkness? and would fat grafting help with tear troughs? I notice how hollow around my eyes are so I genuinely am curious. Thanks!

Robert M. Lowen, MD · Answer

This condition responds well to stem-cell enhanced fat transfer and pigment lasers like Aerolase, a laser that is good for all skin types.
  The hollowing in younger people is genetically caused, and in older people, by the aging process, and the fat and bone resorption that accompanies it.
  I have been impressed with the correction of pigmentation with fat grafting alone. You can also enhance the results, in terms of fat retention and pigment correction, with the addition  of stromal  vascular fraction. SVF is the component  of fat that has a large number of stem cells. I currently use Lipocube to get SVF from the harvested fat and do the grafting with 1/3 SVF and 2/3 microfat under the orbital rim and cheek.  Depending  on the degree of hollowing or cheek volume augmentation needed, two treatments are done.  
   For patients who don't want a surgical procedure, like fat grafting, Renuva is an option.  Renuva is an allograft matrix derived from acellular human tissue (nothing to reject), that when reconstituted with saline and injected into an area that already has fat cells, stimulates those  far cells  to multiply and enhance volume. Result are obtained over a 3-6 month period and a second treatment can be done if needed.
   As an adjunct, depending on skin type, vascular and/or pigment lasers can help diminish the dark circle appearance.

Donald B. Yoo, MD, FACS · Answer

Based on your photos, adding volume to your infraorbit/undereye would likely improve the appearance of hollowing and darkness under the eye. While it's difficult to assess on photos alone, there may also be a component of lower eyelid fat prominence that may need to be addressed simultaneously so that the contour is smooth, instead of a bulge with a depression below it.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin. This is a great question. Based on your concerns, I recommend treating the area of concern with a combination of undereye filler and PICO laser. However, I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117, just call and ask for Jess :) I hope this helps and best of luck!

Zoran Potparic, MD · Answer

Based on these photos you seem to be a candidate for periorbital fat grafting. A combination of micro and nano fat grafts would create significant improvement. Sometimes 2-3 stages may be needed. In person or teleconference consultation with a board certified plastic surgeon with expertise in this procedure is recommended. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

Pigmentation around the eyelids is really difficult to treat.
Treatments that lighten the skin are going to be non-selective and will not create natural blending the way your body has.
Any treatments powerful enough to actually work can create very clear, de marketed, treated versus non-treated areas with White on Brown without transition.
This Will look much worse.
Treatments that are gentle and reduce the risk of having the skin go from dark to white are also not going to do very much and give you temporary improvements at best.
Look for laser experts, especially those in academic medical centers.
And your case that would be UC Davis Medical Center.
I would probably check with a dermatology department to see who is their foremost laser expert .
When it comes to treatments considering the impact, it’s probably better to be cautious and do test spots to see how you react to any particular treatment or energy setting.
In terms of volume restoration fat transfer is unpredictable, imprecise and unforgiving in this area.
Fillers are way better, because fillers are predictable, precise, and forgiving, if you don’t like the outcome.
 Finding providers who can do volume restoration in the face using fillers really well is another question.
Finding the right providers is often by far, the biggest hurdle, and the most important variable.
Of the two volume restoration is more doable, but there may be IPL or laser treatments that can lighten the pigment the question is, will it look natural and be better than what you have now?
Best,
Mats Hagstrom MD.

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