Which treatment is the most successful for dark circles/puffiness under eyes?

I am 35 and have had this problem my entire life. I am too young to constantly look this tired and old! I am curious which treatment would be the most successful. Should I travel to LA for Coolaser (seen on TV)? Are there other laser treatments that are better for this? I would prefer laser versus injections because the longevity of the results. Any help is appreciated. Thank you.

Doctor Answers 9


I always think it best to start with the least invasive approach. Schedule a consultation with a board certified plastic surgeon in your area to be assessed in persona and discuss whether or not a bit of HA filler in the tear trough area will deliver the results that you desire. It's what I use on myself. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Lower lids

A difficult thing about lower lids is that they should not be approached in a "one-size-fits-all" format. There are many anatomic factors to consider and for each of these there are different treatment modalities. The tricky part is to decide which is/are best for your specific situation and how motivated you are to undergo the presented treatments.

From the single photo you posted (and the fact you'd prefer to avoid fillers), laser resurfacing +/- a transconjunctival lower lid blepharoplasty would be a reasonable starting point. 

Do some research and see an experienced board-certified oculoplastic surgeon with proven results. He/she will do a thorough exam and discuss specific recommendations/options so you can come to an educated decision on your treatment plan.

Kenneth E. Morgenstern, MD
Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

A tough thing to get rid of completely

This is the toughest question I get asked in my cosmetic oculoplastic surgery practice, so you are definitely not alone.  A multi-disciplinary step-wise approach is usually best.  I would start with a transconjunctival lower eyelid blepharoplasty to smooth out the bulging fat pads from under your eyes.  If this does not correct the problem to your satisfaction, laser resurfacing, fillers, and bleaching creams are the next step.  Finally, a good foundation and proper make-up will hide any remaining subtle imperfections.  Be patient and take it one step at a time.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 31 reviews


I would recommend a transconjunctival or transcutanous blepharoplasty.  Laser resurfacing or injections will not correct this.  

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Which treatment is the most successful for dark circles/puffiness under eyes?

Because of a lack of underlying support for your lower eyelids, they swell in response to position, hormones, food, allergies, etc. Chronic :"waxing and waning(up and down)" swelling leads to hyperpigmentation or darkening of the eyelid skin and muscle.

Fat grafting---in experienced hands--- restores support, and enhances circulation leading to a reduction/elimination of morning swelling and resolution of your dark eyes.

Hope this helps

Andrew Kornstein, MD, FACS
New York Plastic Surgeon
4.5 out of 5 stars 15 reviews

Fillers will help

Try some fillers and you will see how much you will improve the circles under your lower eyelids. ALso, micro-needling and PRP as well, will help with dark circles.

Soheila Rostami, MD, FAAO, FABCS
McLean Oculoplastic Surgeon
5.0 out of 5 stars 15 reviews

Fillers or Blepharoplasty

Thank you for the question. The only treatments that I think would work for your lower eyelids are injecting fillers which can last about a year or surgery (blepharoplasty) which is more permanent. You probably can find an experienced oculoplastic surgeon in your area. 

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 140 reviews

Dark Circles under the eyes

It seems from your photo that you have orbital fat pushing through into the lower eyelid region. This could be best addressed with a transconjunctival blepharoplasty. Although lower eyelid fat usually appears after 40, their are individuals who show this condition at earlier ages.

This transconjunctival blepharoplasty can be performed by laser technique which often results in less brusing and less pain.

I hope you found this helpful.

Adam Scheiner, MD
Tampa Oculoplastic Surgeon
4.3 out of 5 stars 35 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately.
All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.

Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 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.