Are my Under Eye Circles and Hollows Related to Sinuses/deviated Septum? Could Restylane Help? (photo)

Late 20's and recently moved to a high alt, dry climate. I've had subtle circles for a while, but in the last year they've gotten much worse. They are a purple/blue and also sunken/hollow, particularly around the tear trough. I've been having nasal congestion issues during sleep, so I saw an ENT who diagnosed a deviated septum. My questions are: -Could the congestion/deviated septum be related to the circles/sunken look? If so, would a septoplasty correct them? -Would Restylane be a good option for me?

Doctor Answers 8

Hollows and under eye circle treatments

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thanks for the questions and including photos. Nasal obstruction from deviation of your nasal septum is not related  to your eyelid contours. From your photos you appear to have a slight amount of orbital fat pushing your lower lids forward and creating a bulge. This can be removed with a lower lid blepharoplsty procedure. Alternatively the bags can be camouflaged temporarily with injection of fillers around the area such as Restylane.  

Vancouver Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

Treatment for dark circles under the eyes

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Topical products such as Skinmedica dermal repair for eyes can be of benefit.  This particular product has Boron in it and helps to reflect the light making the appearance of the dark circles less.  Also products such as this and Retin-A help to thicken the epidermis. Circles under the eyes appear dark because the skin is thin and there are many blood vessels and muscle directly under the skin.  Some patients will benefit from microablative CO2 laser treatment to tighten the skin and  soft tissue fillers such as Juvederm to fill in hollows.

Tear trough, eyelidbags, septoplasty, restylane

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Restylane is a good option for treating the tear trough deformity that is not very deep.

Septoplasty used to improve nasal breathing will not improve the tear trough or eyelid bag.

Please consult with a Board Certified Plastic Surgeon in person prior to making any treatment decisions.

Luis A. Cenedese, MD, FACS
New York Plastic Surgeon

Young face with lower eyelid bags

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is not uncommon for younger people to develop the lower lid "bags" that bother you.

They are not related to your septum being deviated.  They are the result of a relative lack of tissue in that area.  Correcting this with either fillers (Restylane, Juvederm) or your own fat (in the form of fat grafting or lower eyelid surgery) is necessary.  There are pluses and minuses to either solution which you need to discuss with your surgeon before choosing which one is right for you.

What can improve my undereye dark circles?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The two best options for your undereye complaints are dermal filler (Juvederm, Restylane) injections or lower blepharoplasty. Filler treatments are an in office procedure with minimal to no downtime with results that last about 9-12 months. Lower blepharoplasty provides a permanent improvement. Surgery takes about 45 minutes and has one week of downtime. I hope this information is helpful.

Stephen Weber MD, FACS

Are hollows under eyes related to deviated septum?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Although hollows under the eyes could be exacerbated by allergies, I do not think that your deviated septum has any relation to them.  I don't think that having a septoplasty would correct the hollows.  It does appear that Restylane could be of benefit to you to improve the sunken area under your eyes.  I would consult with a physician who is experienced with injectable fillers.

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Non-surgical procedures to improve dark circles and hollowing

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is some relationship between the under eye area and the sinuses but it is usually more of a fluid-type of relationship. Whenever the sinuses get congested or there’s an allergy, there is a common pathway where everything drains and it is located behind the eye. Very often that area can have some fluid. Now in your case, that’s not what we’re talking about. With you, it’s more about the thickness of the tissue and the volume in that area.


The area from the eyelid to the cheek, which we refer to as the eyelid-cheek junction or a transition point of the tear  trough area, is an area with some variability.  A lot of people are just genetically very thin in this area. We end up seeing it is a relatively bluish color because we’re basically looking through skin that’s almost transparent, and the color is from the blood vessels.

We look at this area in a couple of different ways. One, we look at the cheek area and see if any volume may be added to the cheek. When you’re young, we’re not interested in having you do a lot of procedures that are typically more age-related procedures. However, conservative options may be something worth entertaining.

 In our practice, we do procedures such as the use of platelet rich-plasma or platelet rich fibrin matrix to help add some collagen and improve skin quality. This is a leading edge procedure where platelets from your own blood and is spun down for a pure platelet concentration which has growth factors. These growth factors work very well in improving the skin quality and building the collagen under the skin. In addition to this, we also routinely use hyaluronic acids such as Restylane to add some volume and to help soften the tear trough area.


As far as answering the question about the sinuses, you may manage your sinuses and deviated septum but I wouldn’t expect too much of a dramatic change in the skin quality under the eyes. It should be potentially addressed with a variety of approaches using natural methods as well as with injectable filler. I hope that was helpful, and thanks again for your question.

Dark circles under eyelids

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The bags present on the lower lids represent fat herniation of the lower lids.  This is best treated with a transconjunctival blepharoplasty approach to the lower lids.  A deviated septum has no bearing on these fat pads. Lower lid bleph and a septoplasty can be performed at the same time under one anesthetic. Make sure any allergies are also addressed if present.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.