Juvederm and Vascular Laser Under Eyes for Hollows and Purple Shadows?

I use a combination of BL treatment and deep fillers to address this problem.  Doing fillers without an energy treatment to get rid of the discoloration will make the discoloration more apparent

The V-beam laser helps some paitents with a reddish to purple color of the lower eyelid skin but many do not obtain benefit. Fillers such as Restylane for the tear trough can help smoothen the contour and create less shadow effect, but the hollow that extends to the eyelid margin can't easily be filled. Although some physicians use Juvederm for the lower eyelid area, I find that there might be less swelling in this location if Restylane is used rather than Juvederm.  Fat repositioning can help recontour as well. There are risks with all of these procedures and no guarantee of success.

The majority of the "dark circles" you have is likely from "shadow" effect, from hollowing underneath your lids (tear troughs).  You should get the filler injection done first, and if you still need it, you can get laser later.

Dr Taban

Be careful. It all depends on your particular anatomy.  As far as correcting the contour defects, fat can either be removed or repositioned to improve the contour and reduce the shadow (if the darkness is a shadow from slightly protruding fat.)  If the darkness is from underlying vasculature showing through, you can try a vascular laser but they may not be effective. Be patient. The same is true if the darkness is due to pigment in the skin.  It is not an easy problem with an easy solution.  If you try the laser treatments, try them before the filler because the laser may break down the juvederm.

Be careful as fillers may worsen your problem!  If the dark purple color is from hemosiderin, the chemical from blood that has been pooled in an area, like the lower lids, then filler may add pressure to the already leaking vessels and the discoloration may worsen.  You can try IPL treatments first and if there is a good response, you might consider fillers after; however, the IPL may not be able to get close enough to the area causing the problem, as the eye must be protected during the treatment.  In your case, surgery may be your best option...with fat transposition and control of the vessels.

Best of luck,

Dr. Michelle Yagoda

NYC Facial Plastic Surgeon

The depressions of your lower lid cheek jucntion can certainly be augmented with fillers. I have performed surgery to release the depressed area as well when performing a lower lid blepharoplasty.  Lasers may help with fine lines.