Periorbital Pigmentation -pigmentation all around my upper & lower eyelid. What type of treatment would be best? (photos)

Question

Since I was a child I have had a profound line under eye bag & as I started growing up it became darker & darker. There is so many different type of dark circles that idk which direction to go to find a solution. I have pigmentation all around my upper & lower eyelid. When I smile it folds into different bags & no amount of makeup helps(2nd pic). What type of treatment would be best? Laser/fillers? Please help, this has ruined my life, I never leave my house without makeup

Nima Shemirani, MD · Answer

Hi @ss.i2. Thank you for sharing your photos.  You would be a great candidate for tear trough 
fillers. Restylane and Belotero work great.  I recommend seeking treatments from expert injectors who have the skill and experience to precisely inject fillers into treatment areas and avoid risks and complications.

Best of luck,

Dr. Nima

Nelson Lee Novick, MD · Answer

At least from the photos provided, it appears that volume deficit, particularly in the supportive upper cheek, under eye region is a significant contributor to the dark circles seen--quite a common problem in my experience. If this is indeed so here, then the proper placement of an appropriate robust HA filler can help to support the under eye area, diminish the tear trough and dark circles. I would not at all be surprised at how delighted you would be from just this one simple procedure that, in experienced hands, should take no more than about ten to fifteen minutes with immediate results. Make sure to consult a board certified cosmetic dermatologist and ask to see his/her personal before and after photos. Best of luck.

Jason Emer, MD · Answer

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.

Leonard Grossman, MD · Answer

So there are a few interesting points that you have brought up. Number one it looks like you have a lower eyelid bag but yet if you touch it, all you feel is bone. It also appears that the skin is darker in the lower eyelid area and you think it’s because of pigmentation. 
What’s happening here is that you have a hollow area in the lower eyelid making your eye more protuberant than the cheek and with the light being always above your head the eyeball casts a shadow onto the upper portion of the cheek making it look like it’s darker. The best way to treat this condition which is by the way inherited from your father, is by means of fat grafting into the hollowness of the lower eyelid. In my hands the results are extremely natural and permanent. I hope this helps and good luck from New York City plastic surgery

Periorbital Pigmentation -pigmentation all around my upper & lower eyelid. What type of treatment would be best? (photos)

Answers (4)

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