Best Procedure to Remove Dark Circles and Under Eye Hollows?

i am 20 years old and have very bad hollows under the eyes one side is worse than the other and under my eyes it is very dark and gross its been bothering my whole life i really need help what is the best option?

Doctor Answers 18

Avoid Fillers have open fat grafting to correct Dark Circles and hollows under eyes

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Correction of Dark Circles under Eyes is the most common procedure I do. It is very difficult if not impossible to inject a filler or fat into the correct position to plump a true dark circle under the eyes. Furthermore, the action of the Orbicularis Oculi muscle around the eye squeezes and displaces the filler down toward the cheek and most patients I have seen (many) complain that the filler injection made the dark circle worse.

I use a transconjunctival blepharoplasty incision(inside the eyelid) using the laser, release a structure called the Arcus Margunalis which tethers the eyelid skin to the bone and creates the depression which causes the shadow which is the dark circle under the eye. I then place a composite fat graft (a whole piece of fat) beneath the dark circle which plumps the dark circle and reduces the shadow. This has worked well in the majority of 2500 patients over the past 10 years.

Dark Circles Under Eyes?

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Thank you for your question! Unfortunately it is hard to tell which procedure you would benefit from without a photo or examination of your face! I advise you to seek a board certified plastic surgeon and have a consultation.  Best of luck!

Dr Dhaval Patel 

Double Board Certified 

Plastic Surgeon 


Hoffman Estates

Oak Brook

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 100 reviews

Dark Circles And Under Eye Hollows

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Dark circles beneath the eyes and tear trough deformities are two of the most difficult problems treated by plastic surgeons. These problems occur for a variety of reasons and the treatment is entirely dependent upon the cause.

In this particular case, it's virtually impossible to make treatment recommendations without pictures or a physical examination. In some cases, fat pads can accentuate hollows beneath the eyes and cast shadows that give the appearance of dark circles under the eyes. Under these circumstances, lower eyelid blepharoplasty with fat re-positioning is probably appropriate.

In other cases, tear trough deformities may be the primary problem. Under these circumstances, the injection of hyaluronic acid fillers may be appropriate. Finally, pigmentation changes may be related to allergies and other medical problems. When this situation arises, treatment with bleaching creams may be indicated.

It's appropriate for patients with these changes to consult a board certified plastic surgeon. This surgeon should be able to formulate a treatment plan that addresses your anatomic findings and achieves your aesthetic goals.

Advanced surgical techniques

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Dark under-eye circles may be due to 1) relative lack of volume between a protruding lower eyelid bag and descended upper cheek fat, 2) hyperpigmentation of the skin, 3) thinned/translucent eyelid skin with visible underlying vascularity or muscle.

Surgery is really reserved for #1 and, in my hands, the best procedure is an external incision lower blepharoplasty with fat repositioning. In this procedure, fat from the bag is not fully removed but instead "moved" to fill the area of volume deficiency. At the same time, the external incision allows the skin and m of the lower muscle eyelid to be elevated to a higher position (with removal of some excess skin). This elevation also pulls up some of the descended cheek fat (raising the lid-cheek junction).

Anand D. Patel, MD
Brookfield Facial Plastic Surgeon
5.0 out of 5 stars 22 reviews

Treatment for Dark Circles and Lower Eye Hollows

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There are a variety of causes for dark infraorbital circles.  One is excessive pigmentation that can be treated with a bleaching cream.  The second is the shadowing that takes place under lower lid bags, which can be improved with lower lid blepharoplasty.  The third is are tear troughs that can be more difficult to treat, including the injection of a filler.  The fourth is hypervascular skin that can be related to allergies, that are nearly impossible to treat.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 145 reviews

Let's be honest, there is no way to remove dark circles.

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Under eye hyaluronic acid filler represent the current best method of helping this dark circles.  The filler changes how light interacts with the skin and this change causes the dark circle to look much better.  These treatments can last well over a year.  This method works very well and for that reason, it is now recommended instead of laser or surgery for these issues.  However, everyone is a bit different and I encourage you to actually see cosmetic surgeons who specialize in treating the dark circle.  It is important to understand that your potential injector needs to be highly versed in the anatomy of the lower eyelid and midface.  Also these treatments are a bit of an art form and an adjustment of the service may be needed.

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

Treating under eye hollows

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The best and safest procedure for reducing under eye hollows is usually fillers.

I urge patients to be very cautious about this area.

Fat injections can leave permanent lumpiness that is very difficult to correct.  We have seen many cases of patients dissatisfied with under eye eye fat injections.

Some hyaluronic acid fillers work better than others; I also urge patients to avoid semipermanent or permanent fillers for this area as well.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Best procedure to remove dark circles and under eye hollows?

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 A full set of facial photographs are required to make a determination about what is really going on with the lower lids. Dark discoloration of the skin is best treated with makeup. Fatty deposits in the lower lids creating puffiness  and the bulges is treated with a lower blepharoplasty procedure. It would be very rare to undergo a blepharoplasty procedure at age 20. For many examples of cosmetic blepharoplasty, please see the link and the video below

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Find the "Best" Procedure to Remove Dark Circles and Under Eye Hollows by answering "Why?" First

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Dark under eye circles and hollows are a very common area of requested cosmetic treatment for both men and women. They often result in a "tired, worn out" appearance that does not reflect how someone actually feels.

When researching treatment options, it is important to identify WHY these hollows and circles form. Treatment providers must consider several factors that may be concomitant issues, including: allergies ("allergic shiners"), skin pigment changes, skin vascularity, changes in skin thickness (fat and subcutaneous collagen content), periorbital fat herniation, periorbital ligament position, unfavorable orbital anatomy, malar fat pad repositioning, bone resorption, and other midface soft tissue changes with age.

In review, the "BEST" treatment is most likely a multifaceted approach combining medical management of allergies, application of cosmetics, non-surgical interventions, and surgical procedures to address each individual patients need.

I advocate avoidance of a one-size-fits-all approach to this issue. Start low and slow with conservative non-surgical measures first, especially in young patients (< 40 years). Older patients (>55 years) are less likely to obtain the results they would like without surgery, but non-surgical options should be discussed first. Turning up the aggressiveness of treatment and pursuit of surgical intervention can always be pursued later, but difficult or impossible to reverse.

Thank you for your question.


It depends on the problem

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It depends on the reason for the hollowing undereyes and tear troughs. Usually there are a few factors at play. 1) excess loose skin 2) orbital fat herniation forming bags 3) volume and fat loss from the cheeks. Therefore, depending on what is needed, the strategy is to remove excess orbital fat (conservatively), remove excess skin, and add volume to the cheeks. So the best procedure is the one that addresses the problem that YOU have.

Jeffrey Jumaily, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 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.