Dark sunken under eyes, plus wrinkles and I'm only 29 yr. They get worse when I smile. Should I get a filler or surgery? (photo)

Restylane or Blepharoplasty

Doctor Answers 6

Laser resurfacing and Botox may be best option for wrinkles under eyes

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Thank you for your question.  I agree with others that a paralytic agent such as Botox or To sport will reduce muscle activity and help the wrinkles somewhat.  Next

I definitely would not do fillers and think your too young for surgery and I do not think surgery would help.

However combined laser resurfacing with fractional erbium 1540 and 20/9/40 laser could help the excess skin.

For more information on combined laser resurfacing please read the link below.

Surgery or fillers

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Thank you for your picture. I definitely would not recommend Restylane injections for the wrinkles of your eyelids.  I do not believe I would recommend surgery either. It appears you do not have any excess eyelid skin. Your wrinkle is due to increased muscle activity. I would recommend good skincare regimen and a hydroquinone to help lessen the darkness of the lids.

Dark lower eyelid circles have multiple causes that must be treated specifically.

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Darkness on the lower eyelids can be caused by 1) concentration of pigment due to fine wrinkles bringing skin melanocytes into close proximity  (this can be treated by resurfacing and sometimes by Botox or Dysport for a hyperactive "banana roll" under the eyes), 2) true hyperpigmentation common in ethnic skin (this can be treated with a q-switched laser), 3) post inflammatory hyperpigmentation caused by eczema or skin irritation (treat the underlying skin condition, 4) a shadow caused by a hollow spot (filler helps only this problem), 5) darkness caused by the reflection of light from veins in the lower eyelid (this can be treated with laser).  Check with an expert to get the correct diagnosis and then you can get the best treatment.  

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Restylane for hollowness under eyes

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Filler in the under eye area can be very beneficial for "sunken" eyes and darkness.  This area is very unforgiving when treated with filler. It must be injected by an experienced injector as Tyndall effect {blue cast to skin} if the product isn't injected deep enough or over correction can result in an unnatural look.

Richard Parfitt, MD
Madison Facial Plastic Surgeon
4.4 out of 5 stars 36 reviews

Circles under eyes

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I agree with the prior post, surgery is not a good option for you, botox/xeomin would be your first best bet, then consider filler, an exam or better photos would be more helpful.

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 104 reviews

Dark sunken under eyes, plus wrinkles and I'm only 29 yr. They get worse when I smile. Should I get a filler or surgery?

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I would try filler first over surgery. Even microBotox would be a better initial therapy. Best to seek expert injecting docs. 

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