I have extremely hollow dark eyes what options do I have to fix this ? What would be the best option? (photos)

Question

I'm healthy 31 year old female. I have extremely dark hollow under eyes even with any amount of sleep. They are so dramatic that when I don't wear make up people assume I'm sick. I have good iron levels eat and exercise. What options do I have to fix this ? I'd prefer permanent options but I'd take anything options. I believe this is hereditary. I attached pictures to show these are taken when the bags are at their best least noticeable without make up.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Dark, under-eye hollows can be treated by restoring volume with dermal fillers or facial fat grafting. Both solutions can provide a subtle increase in volume to this area for a supple and youthful result. A great deal of skill and precision is required to treat this sensitive area and achieve the best possible results. My office uses a micro-cannula to minimize bruising and swelling and achieve the smoothest outcome.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or expert injector. They will be able to discuss your concerns and goals with you and help you decide on the best treatment.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or expert injector. They will be able to discuss your concerns and goals with you and help you decide on the best treatment.

Randal Haworth, MD, FACS · Answer

Thank you for your question. Based on the pictures you provided, it appears that you have prominent tear troughs, which can create the appearance of dark hollow under eyes. This can be a result of genetics, aging, or weight loss.

There are a few options to address this concern, both permanent and temporary. One option is to have dermal filler injections to fill in the hollows and provide a more youthful appearance. Hyaluronic acid fillers, such as Restylane or Juvederm, are commonly used for this purpose. The results typically last 6-12 months, and repeat injections will be needed to maintain the results.

Another option is fat transfer, which involves transferring fat from another area of your body to your under eyes to create more volume. This procedure is more invasive than fillers, but the results can be longer-lasting.

Surgery is also an option, but it is more invasive and carries more risks. Blepharoplasty, or eyelid surgery, can be performed to remove excess skin and fat in the under-eye area, which can improve the appearance of the tear troughs. However, this option may not be appropriate for everyone, and a consultation with a board-certified plastic surgeon is recommended to determine if this is the right option for you.

It is important to discuss all of your options with a qualified professional, as they will be able to provide you with a personalized treatment plan based on your specific concerns and goals.

Best of luck !

Giuseppe Fiore, MD · Answer

Hi,
Thanks for your question and photos. 
There are various possible causes of under-eye dark circles, including genetics, aging, allergies, and lifestyle factors. Since you mentioned that you believe this is hereditary, it's possible that genetics play a role in your case.
 It is a very delicate area that with aging process is accentuated. Tear trough area is on most the most challenge but also rewarding area to treat. There are several treatment options available to address under-eye dark circles and hollowing, including:
Dermal fillers: Hyaluronic acid-based dermal fillers can be injected into the tear troughs (the hollows beneath the eyes) to add volume and reduce the appearance of dark circles and hollowness. The treatment required the right filler injected in the right place/layer in order to reduce this depression, giving the face a younger and less tired appearance. I personally use a blunt cannula in order to reduce possible risk of complications in this particular anatomical site.
Platelet-rich plasma (PRP) therapy: PRP therapy involves extracting your own blood, processing it to concentrate the platelets, and then injecting the platelet-rich plasma into the under-eye area. The growth factors in the PRP can stimulate collagen production and improve skin texture, reducing the appearance of dark circles and hollowing.
Laser or radiofrequency treatments: Laser or radiofrequency treatments can be used to stimulate collagen production and improve skin texture in the under-eye area, reducing the appearance of dark circles and hollowing. I personally use Morpheus 8 with the right energy setting and/or Exilis Ultra 360. 
Blepharoplasty: In severe cases, surgical intervention may be necessary. Blepharoplasty is a surgical procedure that involves removing excess skin and/or fat from the eyelids and under-eye area to improve the appearance of dark circles and hollowness. However , in my opinion, you are NOT candidate for blepharoplasty. 
In addition to the above treatments, there are also some skincare options that may help improve the appearance of under-eye dark circles. These skincare options can be used alone or in combination with other treatments for better results:Topical creams (vitamin C, vitamin K, retinol, caffeine, and peptides), Sunscreen (SPF 30 or higher), lifestyle modifications ( getting enough sleep, staying hydrated, reducing alcohol consumption, and managing stress). 
I would recommend to seek advice of an expert aesthetic doctor with extensive knowledge in facial anatomy i.e. tear trough area.
Hope this helps,
Best Wishes,
Dr Giuseppe Fiore

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.

Nelson Lee Novick, MD · Answer

The upper cheeks are a main support for the infraorbital region. When there is volume deficit in this region, hollowness, dark circles and bags will almost inevitably be present in the under eye region. This seems to be clear.ly the case from the photos provided and is a rather routine problem in any active cosmetic dermatology practic. So, if this is indeed so, the the use of an appropriately robust HA filler to contour the upper cheeks will very likely significantly improve the issues of your concern under the eyes. Should it be still necessary, the additional use of a low viscosity, cohesive, malleable HA filler can further directly improve the under eye region. You would be wise to make certain to consult with an experienced, board certified cosmetic dermatology injector. Best of luck.

Tanya T. Khan, MD · Answer

Hi, you appear to have some hollowing under your eyes as well as some darkening of the lower eyelid skin. The best combination of treatment for you would be to consider tear trough filler as well as a topical hyperpigmentation corrector. Please visit an experienced oculoplastic surgeon for best results with your eyes.

Peter Andolina, DO · Answer

I have 2 treatment options that I think you may want to pursue.  Unfortunately, neither is exactly permanent.  The first would be to try some undereye HA filler.  Filler can definitely help with the hollowness and may also help to reduce some of the darkness in the area.  The other option would be PRP injections to the undereye.  PRP is a little better in treating the darkness but its treatment of the hollowness is more subtle and can take longer to get results because it works by stimulating collage production which is never quick. You may need multiple treatments of the PRP.

Camille Cash, MD · Answer

From your photos you appear to be a good candidate for under eye filler.  This can add volume and improve facial contours.  The treatment is done in the office with the results lasting approximately a year.  See an expert injector near you for treatment.  I've included a video I hope you find helpful.

Leonard Grossman, MD · Answer

You would make an ideal candidate for fat grafting around the eyes, which will restore the volume to your cheeks, lower eyelids, and possibly even eyebrows, if desired . This should create a natural appearance to the face with the results, which should be practically permanent as long as the procedure is done by a plastic surgeon with lots of experience in fat grafting techniques. I hope this helps and good luck from New York city, plastic surgery.