What's the best treatment option for my under eyes? (Photo)

Question

I'm a 34-year-old woman — I’ve had genetic dark circles my whole life, but I’ve also worn glasses my whole life so they never really bothered me…until now. I recently got LASIK, and now my under-eyes are staring me in the face (literally) and I’m wondering what the best option is. Would something like retinol work? I've read some concerning stuff about what happens to under-eye filler; yea or nay? Do blepharoplasty, fat transfer, or lasers seem like the answer? Thanks!

Nima Shemirani, MD · Answer

Hi @linden99! I would recommend a lower lid blepharoplasty in your case. I wish you the 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.

Cory Bovenzi, MD · Answer

Hi and thanks for your question!
The undereyes can be tricky areas for many reasons, including the difficulty assessing off a single photograph. However, my bet would be that the "bags" you're seeing is undereye fat pseudoherniation and would be helped by a lower transconjunctival blepharoplasty. I would also add that achieving a more structured midface/ undereye area would be possible through also having volume placed in the lid/cheek transition area and midface area. In my opinion, a transconjunctival blepharoplasty with fat transposition to the lid/cheek junction and midface would give you the best result. Best of luck!

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photo. You have a little fat protruding from the lower eyelids, mild irregular pigmentation and thin skin revealing the fine blood vessels beneath it. You could possibly improve the appearance of your lower eyelids with fillers and erbium laser skin resurfacing. Surgery might be another option the fillers don’t help. See an experienced oculoplastic surgeon for detailed evaluation and treatment. Good luck!

Marc Polacco, MD · Answer

Thank you for your question. There are a variety of factors to consider when approaching the lower eyelid, including fat pad prominence, skin laxity, and volume loss. Based on your photo, likely the best treatment would entail a lower blepharoplasty with fat transpositioning. Eye creams are great, but I think ultimately the surgery will get you closer to the result you're envisioning. I would be careful with under eye filler. It does help add volume and smoothen the transition from the eyelid to the cheek, but in patients with more prominent lower eyelid fat pads, it can make the area look more puffy. I hope this is helpful, and I wish you all the best.
-Dr. P

Jeffrey Lisiecki, MD · Answer

You should be seen in person to be examined, but you have a full tear trough all the way across and some bulging fat in the undereye. Undereye filler would not be a good idea--you can't really fill across the full tear trough and it would not look natural. Based on what I see in your photographs, your best option would be lower eyelid blepharoplasty, transconjunctival fat removal, fat grafting to the cheek (not so much you look really different, it just helps support the lower eyelid), and some fat grafting to blend the tear trough as well. If you want to avoid surgery entirely, some cheek filler would help a bit. Definitely be seen in person to really evaluate everything that is going on, though!

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! Under eye dark circles are notoriously hard to treat but options do exist. Filler can sometimes work, though it can create a Tyndall effect which may make the darkness worse. Fat transfer could be a good option but it's more for volume rather than coloration. There are creams like hydroquinone and Biopelle Dark Circle Relief which provide lightening of the skin. IPL can be used as well to make improvements. I would seek consultation with a facial plastic surgeon to see what's the safest and best option for you. Hope this helps!

Mobin Master, FRANZCR, MBBS · Answer

What we do for a patient like yourself is to start with pigment treatment such as PICO laser or REVLITE to get rid of the dark pigment first. Then some skin tightening using HFU. Once this is done, assessed by a good clinician to see if your eyes are hollow/ sunken AND you skin is strong and not loose in the undereye to consider filler (LAST STEP). Undereye filler has the greatest issues for patients, but younger age seem to do a bit better.

Dallas Walker, MBBCh · Answer

Hello there!
The under eye area can be such an annoyance for people. What I can see in the photo looks largely like a collection of lymphatic fluid. As we spend a quarter to a third (the lucky ones) of our lives sleeping, this gives the opportunity of the fluid to gather. Lymphatic fluid relies on muscular contraction to move. Genetics and other factors certainly play a role here to though. The muscles under the eye are quite thin and other than intense squinting, the process of draining lymph is fairly passive.
You will want to be careful with the use of fillers under the eyes, if they are not placed deep in the correct plane, it could make the area worse. I would such a consultation with a medical aesthetics professional to guide our treatment process, but you could look at treatments like morpheus8, PRP, midface support with dermal fillers. There are a lot of options... so don't loose hope!!
I hope you are well!
have a great day!
Dr Dallas Walker

Akshay Sanan, MD, FACS · Answer

Dear linden99,Thank you for your question and photo. You have fat bag protrusion, and flat cheeks. The combination of the two makes your under eyes appear tired. The dark circles are a skin pigmentation issue and can be improved with microneedling with PRP. For the under eyes I would recommend a blepharoplasty (transconjunctival) with fat removal and fat grafting to the cheek and the under eye. The purpose of the fat grafting is to add support and shape to the cheek and under eye areas. I recommend you consult a board certified facial plastic surgeon for a thorough consultation.All the best,Dr. Akshay SananDouble board certified facial plastic surgeon

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