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 11

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

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?

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 

Chicago

Hoffman Estates

Oak Brook

Dhaval M. Patel, MD
Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 86 reviews

Dark Circles And Under Eye Hollows

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

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 18 reviews

Eye bag treatments, younger people

There are many causes of eye bags. Some are shadow issues, some are discoloration issues.  Most people have a multifactorial issue meaning they have more than one problem causing this demarcation.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Treatment for Dark Circles and Lower Eye Hollows

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
4.8 out of 5 stars 124 reviews

Lower Eyelid Hollows

The hollows can be treated with fillers. Be sure to consult someone who has extensive experience with this area. You should also not expect to have a totally satisfactory result. Partial correction may be all you can expect. If there is actual discoloration from pigmentation, you may find that skin bleaching helps a little too.

Hugh McLean, MD
Mississauga Plastic Surgeon
3.8 out of 5 stars 7 reviews

Dark circle and hollow under eye correction

  It's tough to make recommendations without a photo but IMHO if you have lower eyelid hollowing, the best option is a thin soft tissue filler like Restylane or Juvederm.  Fat is not reliable and can absorb unevenly leaving the thin skin, in this area, bumpy and unsightly.  The same can be said for thicker or permanent soft tissue fillers that are meant to be placed in places where there is a fatty layer with which to place them....the lower eyelid thin skin has no such layer and therefore these thicker (Radiesse, Perlane, Juvederm Ultra Plus) or permanent fillers (Artefil) should not be placed here.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

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

Miguel 

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
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 25 reviews

Treating under eye hollows

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 153 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.