What is the best treatment for my under eye? (Photo)

My under eye circles and hollowness came on within the last 6 months. What direction should I go that will give me the best results?

Doctor Answers 6

Under eye hollowing is due to volume loss, and hyaluronic acid fillers are the best treatment for the thin skin of the eyelid

The majority of your concern is in the area called the tear trough. There’s also an area adjacent of it towards to the center of each eye which is called the V-deformity or the junction between the eyelid and cheek. As we get older, we lose some volume in both these areas.

I’m a cosmetic oculofacial plastic surgeon and I specialize in eyelid surgery and rejuvenation. I’ve practiced in Manhattan and Long Island for over 20 years. Presently, we now have more options used for dealing with this type of volume loss. In our practice, our approach is to address volume with a filler such as hyaluronic acid. Hyaluronic acid comes in many different brand names including Restylane and Juvederm. It can really be very effective in restoring contour in the really delicate eyelid area. The trick is to be able to place the material and avoid lumpiness, irregularities and swelling. There’s an art to the placement of the fillers so that patients can get significant improvement. The eyelid is the thinnest skin of the body and it rests against the bone, so when there’s less tissue in between, it makes the area very dark. A filler is a great solution and is worth exploring. The downside of fillers is there is maintenance involved. Sometimes, surgeons get a little ambitious and fill too much more making the eyes look puffier.

There are also times people want to go for something permanent such as fat transfer. From my perspective, I have not seen very good results from fat transfer. Fat grafting unfortunately does not really apply uniform filling. People come to me from all over the world that had fat grafting and I actually had to remove the fat because it created these irregularities and lumps.

In addition, we also do something unique called platelet-rich plasma treatment. Platelet-rich plasma or PRP is derived from your own blood. We concentrate the platelets and growth factors necessary for wound healing and apply them under the skin. With PRP there is improvement in color, quality and the overall health of the skin. In fact, when we use PRP in the rest of the face such as acne scars or just for complexion improvement, the patients always come back with this nice glow because it stimulates blood supply that makes it really different from fillers. We do a filler for the volume and PRP to improve the skin quality as a synergistic approach that received a very high level of satisfaction from our patients. We follow our patients closely to make sure the contour and shape is really nice and always tweak if necessary. Again, this is an art and it has to be done artfully to get the material in the right place, volume, and shape.

These fillers can last anywhere from 3 months, 6 months, a year, and sometimes even beyond, but it does depend on the the individual so you have to see what works for you. Facial aging is volumetric loss which is the loss of bone, muscle and fat, so restoring volume strategically and keeping a natural look is important and a commitment. I hope that was helpful, I wish you the best of luck, and thank you for your question.


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New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Lower Eyelid Circles

It appears from your photo that you have lower eyelid "grooves" that can be improved with either Restylane or Juvederm-Voluma. Both products do not swell significantly therefore they are the easiest and best non-surgical solution to correct the volume deficits. If you opt for a long lasting surgical approach I would probably recommend lower eyelid fat grafts however because it does not appear that you have a significant amount of  prolapsed of eyelid fat above the grooves  I would not recommend a procedure to transpose fat from your eyelids 

Joel E. Kopelman, MD, FACS
Ridgewood Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Eyelid contour #hollow eyes #microfatgraft #darkeyes

Dear SummerRN

Thank you for your question and photo!  For the area under your  eyes- you can either add shape with a filler like Restylane or have a more permanent result like micro fat grafting.  Both give excellent results.

With Warm Regards
Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 107 reviews

Options for Under Eye Dark Circles

The dark circles under your eyes caused by depressions in the area can be permanently corrected with surgery or temporarily camouflaged with fillers. Surgery would require a fat-repositioning lower lid blepharoplasty. In this surgical procedure, fat from the eye area is moved into the tear trough depression filling the depression.

There are great non-surgical option to fill in under eye depressions and hollowness. Using dermal fillers, a liquid eyelift can be performed. Dermal filler such as Restylane would be placed in the cheek and tear trough to hide the depression or bag underneath your eye.

Many times patients will try the non-surgical option first to see if they are happy with the result. If they do not get the results that are seeking, they can still undergo surgery. Other patients want a permanent solution and choose to undergo surgery.

At times, patients will have a darkening of the skin in this region. This staining of the skin can be difficult to treat and will not improve with either a liquid eyelift or a lower blepharoplasty.

Each of these choices are viable options. I would carefully review the pros and cons of each procedure and decided what would be best for you.

Treatment of Under Eye Circles ands Hollowness

With out an examination it is impossible to say what will work best for you. However, both fillers and lower blepharoplasty can correct these problems. See a plastic surgeon specializing in eye rejuvenation and expert in both blepharoplasty and use of fillers.

Robert T. Buchanan, MD
Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Lower blepharoplasty

A lower blepharoplasty or eyelid lift is probably going to be what you need.  This would remove the puffiness and tighten the skin.

John Zannis, MD
New Bern Plastic Surgeon
4.5 out of 5 stars 49 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.