Best treatment for dark circles, blepharopasty or filler? (Photos)

Question

Hi, I’m a 44 yo man of indian origin. I’m considering treatment for my under eye dark circles but the hyperpigmentation is actually all around the eye. Should I consider a blepharoplasty? There isn’t as much fat, in fact, if anything, the skin is thin and hollow. Or is there another treatment that is more preferred?

Anna Chacon, MD, FAAD · Answer

Looking at your photo and reading your description, it seems like the main issue isn’t excess fat or droopy eyelids but rather thin skin, hollowness, and generalized pigmentation around the eyes. In this scenario:

Blepharoplasty (eyelid surgery) is usually intended for:

Excess upper or lower eyelid skin

Bulging fat pads under the eyes
Since you don’t have much fat or loose skin, surgery may not address your main concern and could even make hollowness more noticeable.

Filler – specifically hyaluronic acid fillers in the tear trough and surrounding hollow areas – can be very effective for:

Restoring volume under the eyes

Softening the shadow and reducing the appearance of dark circles caused by hollowness
It won’t fix pigmentation itself, but by filling the hollows, the shadows and contrast that make dark circles appear worse are minimized.

Additional options for pigmentation:

Topical treatments with vitamin C, hydroquinone, or retinoids

Laser or light-based treatments to target pigmentation and stimulate collagen

Microneedling with PRP can improve skin texture and tone

Summary: For your situation, filler combined with skin-lightening treatments is generally preferred over blepharoplasty. Surgery would not likely improve the appearance and may risk accentuating thin skin.

Best treatment for dark circles, blepharopasty or filler? (Photos)

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