Best Procedure to Remove Dark Circles and Under Eye Hollows?

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).

The short and honest answer: You can't really remove dark circles. But don't get disappointed, because there are ways of treating dark circles so they become much less noticeable. But first before treating dark circles you need to know what you are treating.
1. Hollowing: some people have true under eye hollows loss of fat (atrophy) or enlargement of their eye socket over time. This can contribute to the appearance of dark circles because of shadowing effects. The best way and probably quickest way to treat hollowing is with dermal fillers. There are many different types of fillers and we can get into a longer discussion another time of what is best to use around the eyes.
2- Pseudo-hollowing: this is the hollowing that is seeing under an eyebag. This person may have loss of volume in the midface or tear trough, but this hollowing is made 10x worse with the appearance of the eyebag above it. It's like having a huge mountain beside a valley. The valley looks deeper in comparison to the large mountain. The best treatment in this scenario is lower lid blepharoplasty to remove the eyebag and reposition the fat into the valley below. This kills two birds with one stone.
3- Hyperpigmentation of the skin: some patients because of family history or ethnicity general have more pigment in the skin around their eyes. This is probably the most difficult to treat. However, there are lasers, IPL and skin creams that can help improve your tone. But don't despair. You just need someone to point you in the right direction. Consult your favourite skin care specialist or oculoplastic surgeon :)

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Thank you for your question. There are a variety of options for removing dark circles and refreshing the area under the eyes. The quickest is injectable filler in the tear troughs. This treatment places small amounts of filler into the area under the eyes to add subtle volume and diminish the dark circles. We use a blunt-tipped micro-cannula to treat this area rather than a needle, to create a smoother result and minimize post-treatment bruising. If the skin is crepey, laser resurfacing can be used here to stimulate collagen production and rejuvenate the skin. If the problem is severe, lower blepharoplasty (eyelid surgery) can be used to remove excess skin and create a smoother contour under the eye. I encourage you to schedule a consultation with an experienced, board-certified facial plastic surgeon who can assess you in person and create a customized treatment plan to meet your needs and goals best.

There are many treatment options for under eye dark circles, depending on the exact cause of the dark circles (hollowness vs pigmentation) and patient's preference and anatomy. Options include filler injection, fat injection, lower blepharoplasty with fat repositioning, soof lift, and implant, each with pros and cons. 

To answer this requires an evaluation.  Dark circles are caused by many things.  Shadowing, eye bags above, and the dark color of the muscle and its blood vessels below (under the skin). Usually fillers, lasers or other energy based devices can help.

Dark circles under the eyes are one of the most common complaints I hear about.  Each case is unique, so seeing an appropriately trained Plastic Surgeon is the best way to determine what your options might be to address this.  The causes of this can include pigmentation of the skin, loss of fat under the eyes, and bulging of fat in the lower eyelids.  This can cast a shadow that makes the circles appear even darker than they actually are.  Treatment can include surgery, adding volume to the cheeks with fillers or fat, or both.  

Each patient is different, but in general, the dark circles under the eyes are caused by a shadow effect due to the lower lid tissue above the tear trough, a deep tear trough, a medical issue such as allergies, thin skin, or just purely genetics. Only a history and physical exam with a well-trained surgeon can help to identify the treatment for each individual. In general, I often recommend non-surgical treatments in younger patients, and surgical treatments in older patients, but each patient is unique.
Surgery can help to decreased the bulge of the lower eyelid that may be causing any shadow and can also help to reposition fat in order to fill in the tear trough. Fillers can help to disguise the tear trough and smooth any irregularities that may be causing a deep trough or contributing to the shadow effect, but fillers are temporary, and can sometimes make the dark color worse or appear somewhat blue in color. Treatment of allergies that may be causing dilation of the blood vessels around the nose and eyes can also be helpful if indicated. As always, a detailed history and physical exam with an experienced surgeon is needed to determine treatment recommendations.
Be sure to see an expert surgeon who specializes in facial aesthetic procedures.
All the best,

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

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 ChicagoHoffman EstatesOak Brook