Dark under eye circles - What are my options? (photo)

Thank you for your question and photo. When the right formula is chosen and administered by a skilled injector, dermal fillers are an effective treatment for reducing the appearance of undereye circles.
RF microneedling may be another option for you. This treatment uses radiofrequency technology to increase collagen production and restore the skin’s elasticity, with results lasting years for some patients. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon and injector who can review your injection history and suggest the best approach for treating your concern.

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.

If I had to guess, I would say that the filler used unsuccessfully in the past was injected directly into the tear trough regions, a mistake commonly made by inexperienced, novice injectors. Volume deficit in the upper cheek region, which is a primary support to the under-eye areas, allows for sagging of the overlying skin envelope, resulting in hollows, tear troughs and even dark circles. An appropriately robust HA filler injected properly in the upper cheek region can often reverse these issues by restoring the supportive volume, whereas simply attempting to fill the tear troughs does not address the underlying problem. Make sure to consult with a board certified cosmetic dermatologist and be sure to ask to see his/her personal befores and afters of under-eye filler treatments. Be wary of claims for this or that, relatively expensive, faddish light or energy-based device treatments, as the hard science to support their use lags woefully behind the heavy marketing to promote them. Best of luck.