Hollow Dark Circles: What to Do? HA Filler, Blepharoplasty, Fat Grafting, Laser? (photo)

Hello Doctors, I have genetic dark circles. Their darkness is exacerbated further by the hollowness around my orbital bone and the indentation of my tear troughs. This is something that would be remarkable for me to fix. I've tried expensive creams w/ no luck & want tangible results. The 2-fold problem seems to only be solved by restoring volume & diminishing darkness. Should I get laser Arcus Marginalis release (transconjuctival incision), fat repositioning, laser therapy? Thank you!

Doctor Answers 2

Transconjunctival Arcus Release and Open Composite Fat Grafting is the Best Solution for Hollow Eye

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There are 3 problems contributing to the Dark Circles:

1. Thin Eyelid Skin- The eyelid skin is so thin that the purple color of the muscle under the eyelid skin is transmitted through the skin-this cannot be effectively changed

2.The Arcus Deformity or Naso Jugal Fold is deep and accentuated because of a lack of normal fat around the eye and frequently there is an unusually deep depression in the bone underlying this area

3. Pigment on the upper layers of the skin.

Many many people have been severely disappointed with filler injections beneath the lower eyelid. Unless they are placed absolutely perfectly by an expert familiar with the anatomy, the contractions of the Orbicularis Muscle around the eyelid actually pushes the filler down out of the depression which makes the depression look worse. Often in inexperienced hands the filler is placed incorrectly and can create visible lumps-sometimes grey discolored lumps.

For over 15 years and in 2500 cases I have found Composite Fat Grafting through a Transconjunctival Blepharoplasty with Release of the Arcus Marginalis an excellent procedure to correct the hollow depression that you write about. It is a permanent solution which does not have to be repeated as do filler injections. It uses your own natural tissue which is an additional plus.

Pigment can be treated with topicals and if necessary the 1540 Non ablative fractional Erbium laser.

The benefits of using the CO2 laser in incisional mode have been well demonstrated in the Medical Literature repeatedly since 2000.

For details on the procedure check the link below

Using a laser to perform lower eyelid surgery will not add anything to your result.

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Given your age and issues, what you need is under eye fillers using Restylane by a surgeon who really knows what they are doing.  I suspect you will be disappointed with lower eyelid surgery.

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

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.