What would be the best choice to get rid of tired looking + little bit dark circles around my eyes? (photo)

I always look tired,without eye make up I can't even go outside.I wish I could have done something to look fresh even without any make up.

Doctor Answers 4

Restylane to fill the groove and bury the minor eyebag

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Hi Ayaat,

In the photo you posted, your chin is down and you are looking upwards.  This particular position will make the eyebags look worse.  When I take a series of eyelid photos, I will have the patient look straight, up and down, at 3 different angles (see the web reference link.)  If you notice the looking straight photos versus the looking up photos, the eyebags look worse in the looking up photos.  

If for some reason your eyebags are bigger than what the photos show, then a small amount of fat removal may help to flatten out the eyebags, but the more important part of the improvement is to blend your upper cheek directly to the eyebag, so it looks seamless.  In order to do this, I think using a Dermasculpt microcannula is particularly helpful.  After injecting a pinhead amount of numbing medicine with adrenaline to constrict the blood vessels on the skin (to reduce the chance of bruising) this small hole punch sized numb skin acts as a spot of numb skin to make a very small needle hole and pass a round tipped Dermasculpt microcannula (a blunt tipped needle) which allows for multiple passes around the rim of the eyesocket while injecting very little filler with each pass.  This allows for a very even distribution of the filler and since very little filler is in any one spot the chance for lumps is very small.  An additional layer of safety with Restylane as well as Juvederm, is that it can be dissolved if for some reason the patient does not like it, if it is very slightly overfilled, or of last resort, some how there is an infection which contaminates the filler (a pimple close to the location of the filler) and antibiotics is not working, then the filler can be dissolved to clear the infection and that area would need to be started over.  This is very rare, but the risk is not zero.

In the past, I would only fill the undereye while the patient's eyes were closed or looking straight.  Now I additionally will fill the same area while the patient is looking upwards, to hide the eyebags even better while they are looking upwards.  This would help if the patient were taking a photo in the similar position you posted.

To expand on Dr. Steinsapir's response, the reason why most doctors don't use Juvederm in the under eye area, is that there is a delayed swelling associated with the Juvederm.  Restylane does not seem to do this.  After the filler is injected smoothly, the Restylane seems to hold its shape, while the Juvederm may look good when the patient leave the clinic, only to have the Juvederm absorb more water a day later.  One interesting fact which corroborates this expansion, is that the original Juvederm syringes were 0.8cc, and not 1.0cc.  They felt the 0.8cc of Juvederm gave an exquivalent amount of filling power as Restylane.  The reason for this is the Juvederm is around 90% hydrated while in the syringe, and after it is injected, the Juvederm will absorb another 10% of water which makes the filling effect greater. Restylane is closer to 96% hydrated, and does not have the same delayed swelling as the Juvederm.  I exclusively use Restylane around the eye area for this reason.  

One argument to use Juvederm is that it lasts longer.  Restylane in the under eyes appears to last around 12-18 months before patients return for a touch up.  I will take follow up standardized photos when they come back for a follow up and the continued improvement even at the 12-18 month follow up means that there is still Restylane left over. The first time they patient has the treatment is also when they use the most amount of filler.  After the "gas tank" is filled up, they usually don't come back unless it is 1/4 or 1/2 depleted, and they will use less filler than they did the first time.

To summarize, it is unlikely that you would need lower eyelid surgery (some surgeons will recommend it), but lower eyelid filler alone will likely give you the results that you are looking for without surgery.  For some patients, would don't mind having surgery or budget is not an issue, they may end up with both a small amount of fat removal, along with some kind of volumization, filler or fat grafting around the rim of the lower eye socket.  The amount of filler you would likely use is around a 1 cc syringe.  For younger patients like yourself, it ranges from 0.5-1.0cc and for older patients 1-2 cc, with 1.5 being the average.  If I were to perform fat grafting alone, I think such small volumes may be too much surgery for so little filling effect, but it is really the patient's decision after weight all Pro's and Con's.

Good luck on your journey.


Dr. Yang

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New York Facial Plastic Surgeon
4.8 out of 5 stars 35 reviews

Permanent surgical removal of eye bags that leaves no visible trace of surgery. Dark circles can be treated non-surgically

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As a cosmetic oculofacial plastic surgeon practicing in Manhattan and Long Island, the phrase “tired of looking tired” is what I deal with everyday in my practice. The puffiness under your eyes is called lower eyelid fat prolapse. Lower eyelid fat prolapse has to do with the anatomy around the eyes. The puffiness is fat pockets that have pushed forward. People often first try topical creams, put cucumbers and teabags. Since the puffiness is a physical volume of fat, these modalities help the skin but don't do anything to the puffiness.

In my practice, for someone like you, our procedure of choice would be transconjunctival blepharoplasty. Transconjunctival blepharoplasty means that we are approaching those fat pockets to reduce and reposition from the inside of the eyelid to avoid any external incision. Therefore, there are no issues with marks or incision lines even though a transcutaneous approach can be done very artfully. In particular, this procedure maintains the natural shape of the eyes. This is something that‘s very important, especially in younger people like you who has a nice natural almond shape of the eyes. We had many patients come to us from all over the world who had an external approach. It’s not the approach itself that’s an issue, but the actual surgery that was done and it resulted in the rounding of the eyes. We have to do very complex procedures such grafting, drill hole canthopexies and other things to restore that almond shape.

For under eye circles, causes are melanin pigment from ethnic variations in skin quality and texture, or maybe from external factors such as environment, sun exposure and allergies. We routinely use platelet-rich plasma to help the skin quality of the lower eyelid skin and then that helps with the dark circle issue. I often recommend the combination of transconjunctival lower eyelid blepharoplasty with platelet-rich plasma which we do routinely in our practice with local anesthesia with LITE™ IV sedation. This way we avoid general anesthesia altogether, and it allows our patients to recover much faster and go back to normal life quickly. It has been extremely successful and effective.

Meet with qualified and experienced cosmetic surgeons. Find one that you click with move forward. I think you’ll do very well with that type of procedure. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Restylane in the under eye circle.

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The service will be fantastic for you.  You need to find a very fussy injector for this service.  Don't get Juvederm for this purpose.  Once the services is set it can last for a year or more.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Eye Bags and dark circle treatment

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The best long term treatment is fat removal and laser skin resurfacing combined with vascular and pigment removal lasers. It can be done as a single procedure. 
Temporary fillers such as Belotero and bleach creams may be used as well.

Gregory Herbich, MD
Honolulu Dermatologist
5.0 out of 5 stars 5 reviews

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.