I have dark circles (hereditary) which is fine I can live with that. How do I get rid of the indentations? (photos)

These indentations left after makeup application are killing me! I look old and tired when I'm not! What can I do about them.

Doctor Answers 10

I have dark circles (hereditary) which is fine I can live with that. How do I get rid of the indentations?

At this stage in your life you can still be pretty conservative with rejuvenating procedures. One of the easiest things to do is have fillers injected. But this is a difficult area and requires someone with very artistic skills. If you like, we can refer you to an excellent person in West Linn that can help. 

Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Dark Circles Lower Lid Treatment

The depressions that cast shadows of your lower lids can be improved with fillers. In this area it is very important to have an experienced injector so as not to place the filler too close to the skin. I would recommend trying Jeuvederm or Restylane first as they are not permanent and can be reversed if you do not like the result. If you do like the result, then fat is a good option for a more permanent correction.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

I have dark circles (hereditary) which is fine I can live with that. How do I get rid of the indentations?

You look very young from the photo to have or need lower eyelid surgery and the photo is not ideal to evaluate things but something more conservative like filler to even out the high and low points may be far more appropriate. See a board certified  surgeon in your area with an expertise in aesthetic surgery for more information. Good luck! Dean Vistnes.

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
5.0 out of 5 stars 48 reviews

Improving the hollow areas and even treating the dark circles with hyaluronic acid fillers and regenerative medicine

As a cosmetic oculofacial plastic surgeon, I can tell that you’re concerned about the area we refer to as the tear trough. From your photos, I think you are a good candidate for a filler like a hyaluronic acid filler combined with platelet-rich plasma. This was a serendipitous discovery a few years ago when we used this in our patients who had an aged appearance to the skin and dark circles. They had improvement in the skin quality and dark circles even if they were genetic. Eyelid skin is affected by aging and environmental changes. It is also affected when someone wears make up and then aggressively takes it off. The chemicals used to wipe off the makeup can often dry out the skin and accelerate aging.

In our practice, we’ve been doing a combination approach of hyaluronic acid filler such as Restylane. This provided volume to fill the tear trough area and the rim between the eyelid and the cheek called the eyelid-cheek junction. We combine that with platelet-rich plasma which helps skin quality. There have been studies done where the combination of hyaluronic acid with platelet rich plasma resulted in improvement in wound healing. We are very pleased with the qualitative improvement in the skin and the area.

During the procedure, I spend a lot of time on every patient where I’ll put a little bit of filler, mold it and come back to the patient after a few minutes to see how it looks. Once it’s done and it looks good, it can make a real improvement on the patient’s appearance. It does require maintenance as there’s no permanent solution. There are some doctors who recommend fat transfer. Unfortunately, it’s been my experience that eyelid skin is very thin and does not do well with fat grafting as it often results in irregularities and bumps. We have had patients who come from all over the world for me to address fat that did not work out so well and they even needed more extensive surgery to remove and reconstruct the tissue.

As far as hyaluronic acid is concerned, there is a safety mechanism associated. We have an enzyme called Hyaluronidase which can melt the hyaluronic acid. We use this for some patients who had excess hyaluronic acid under their eyes.

I suggest that you meet with doctors who have a lot of experience with dealing with dark circles and hollowed areas using with hyaluronic acid. There are some doctors who also use platelet-rich plasma for this area as well. So learn more about these options and start meeting some doctors to find one that you’re comfortable with. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

Tear Trough Deformity

Thank you for your photos.  Filler can help the tear trough but injection in this area is very, very tricky and filler is not a long lasting solution.

Even though you are young, it would be reasonable to consider having lower eyelid surgery through the inside you your eyelid (transconjunctival) and move some of the fat in your lower lid into the tear trough area.  This would soften the transition from your eyelid to the tear trough and often it also improved the dark circles to some degree.  This surgery can be pretty tricky and it's important you select a surgeon with a lot of experience doing this type of fat transposition.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

I have dark circles (hereditary) which is fine I can live with that. How do I get rid of the indentations?

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers, micro-fat grafts, and blepharoplasties. There is no one best procedure. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 reviews

How to decrease the nasojugal grooves (tear troughs)

You are experiencing some hollowing in the nasojugal groove, most commonly termed he tear troughs. This is due to a decrease in volume and sagging of the cheek fat in the upper midface that occurs with age. As the area is mild it may be wiser to start with a non-surgical option such as a hyaluronic acid filler like Restylane. If you like the result you may then opt for a more permanent solution with fat transfer. Fat transfer must be done in a precise manner to prevent lumping in this area where the skin is quite thin but if done correctly can give you a more rejuvenated look.

Kristina Tansavatdi, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 33 reviews

Tear Trough Correction

The depression below your eye is a tear trough. This depression is formed by the sagging of cheek tissue with age, as well as the separation of muscles leaving a depression. This depression can be erased with;
  1. Fat Transfer with a blunt tip micro-injector. This is the best way to treat this problem because it will permanently fix the problem, there is ample supply and the color of fat is great to compensate for skin discolorations.
  2. Other filler like restylane or belotero can cause a bluish color under the skin. It can also appear lumpy under the skin.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 33 reviews

Lower eyelid tear troughs

This is a common area of concern in patients. The groove you are noticing is the depression along the rim of the eye socket which has been called the "tear troughs".
This area can be treated with hyaluronic acid fillers, most commonly Restylane or Boletero. Juvederm is not great in this area as it can cause a bit more swelling.

Another more permanent option is fat transfer. This has to be done in a conservative fashion by an experienced surgeon, as proper placement [deep] is imperative. In the long term, this gives a more natural permanent solution.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Dark circles under eyes

Thank you for your question.  Your best option would be to use a filler to get rid of the depressions.  The rest of your face appears youthful and taking care of orbital rim and tear trough would bring your lower eyelids into better harmony with the rest of your face.  I prefer Belotera Balance to take care of this, but Restylane is also a good product.  Both are hyaluronic acids and very silky (to avoid uneven appearance or nodules under the thin skin of the lower eyelid).  If for any reason you don't like the results, both are reversible as well, but that is unlikely.  All the best!

Sirius K. Yoo, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 27 reviews

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