What can be done to bring back the youthfulness underneath my eyes? (Photo)

I always looked very young for my age until now. the skin under my eyes looks like it stretched and aged rapidly from just a few years ago. I don't want fillers because I want something permanent. I've thought about fat grafting but have read some scary outcomes. What can I do to bring back a youthful appearance?

Doctor Answers 16

Options to Bring Back Youthful Eyes

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The dark circles under your eyes caused by depressions in the area can be permanently corrected with surgery or temporarily camouflaged with fillers. Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the depression.

There are great non-surgical option to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eyelift can be performed. Dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye.

Many times patients will try the non-surgical option first to see if they are happy with the result. If they do not get the results that are seeking, they can still undergo surgery. Other patients want a permanent solution and choose to undergo surgery.

At times, patients will have a darkening of the skin in this region. This staining of the skin can be difficult to treat and will not improve with either a liquid eyelift or a lower blepharoplasty.

Each of these choices are viable options. I would carefully review the pros and cons of each procedure and decided what would be best for you

Options for youthfulness underneath your eyes

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Thank you very much for your question and photographs. From your photos, it would appear that you need filler in your cheeks, below the eyelid, to achieve a smoother cheek/lid junction. This can be most easily accomplished with a long-term filler like Voluma, which lasts for up to two years. I would suggest that you have a consultation with a Board Certified plastic surgeon to discuss having Voluma placed in your cheek/lid junction to improve your contour and take the tired look away from your face.


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Don't dismiss fillers. Based solely on your photo, I think they could be the best solution for your issues. Schedule a consultation with a  board certified plastic surgeon in your area to be assessed in person and discuss options. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

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Hello Jaygee001

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I think you could fix this with fillers anyhow if you are looking into a radical solution then you answer would be a lower lid  blepharoplasty and the removal of the fat under you eyes. Good luck

Dr. Michael J. Rodriguez

Correction of lower eyelids

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Your photos are helpful but perhaps more than any other surgical procedure the ability to physically examine your lower eyelids is invaluable in providing you a thorough answer to your question.  Although you do not provide your age, it appears rom the photos that you are relatively young and had good lid tone with little excess lower eyelid skin.  A transconjunctival lower blepharoplasty with fat repositioning would work very nicely.  If your skin appears to be crepe then a medium chemical peel, erbium, or fractionated CO2 laser at the time of surgery would also address this issue.  


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You have several options.  I agree with the others that fillers are a good options for treatment of your concerns. Fat grafting is also another valid option.  The most aggressive would be lower lid blepharoplasty with removal and repositioning of the fat pads under your eyes.  Good luck

Blepharoplasty for youthful lower lids

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 A lower blepharoplasty procedure can accomplish removing the fatty deposits in the lower lids and tightening excess skin when needed. The fat is removed through a incision on the inside of the eyelid, known as a transconjunctival approach. Any excess skin is removed from an incision at the lash line  and closed with tissue glue in our practice. There are no stitches on the lower lids. For many examples and more information, please see the link and the video below

Under Eye Tear Troughs Respond Well To Fillers

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I concur wholeheartedly that you should rethink your opposition to fillers. I have been using fillers to treat the tear trough and under eye region for over three decades since the early days with the original Zyderm I collagen filler.

My last patient this morning had nearly exactly the same problem that I see in your photos and immediately following a ten minute procedure (approximately five minutes per side) using Belotero Balance) she experienced the "Wow!" response when she looked in the mirror.  

Because the infraorbital area is typically subject to much less mechanical stress, the injected filler may last far longer in this region than when injected in other regions. I have had patients who have maintained their results for three years, even five years. After I treated myself, I maintained my own correction for longer than five years before needing retreatment. Considering that most of us go to the dentist or dental hygienist twice a year, coming back once every two plus years for a ten minute under eye touch up is really not so onerous that one would risk the use of fat injections in the region or even the expense and downtime of aggressive surgery.

A word to the wise: treating the under eye area is not to be left to the hands of novice injectors. So, be sure to seek consultation with a board certified aesthetic physician with experience and expertise in treating this delicate area and of course be certain to ask to see his/her before and after photos before proceeding.  Good luck to you.

You should rethink your opposition to under eye fillers.

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Under eye filler with Restylane performed by an experienced injector is the state of the art under eye treatment.  The longevity of the service is well over a year and has the virtue that the service can easily be adjusted with enzyme if needed.  Grafted fat, micro, nano, or otherwise causes scars in these tissues which are designed to glide over each other.  The grafted fat even done well scars the lower eyelid glide function.  More standard lower eyelid transconjunctival lower blepharoplasty with release of the lower eyelid fat into the top of the cheek (arcus marginalis release surgery) is an option.  Carefully assess your options.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

What can be done to bring back the youthfulness underneath my eyes?

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Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a conservative artistically performed blepharoplasty including micro-fat grafts to the tear troughs will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.