What Can I Do to Fix my Under Eye Area. I Have Wrinkles and Dark Circles? (photo)

Can I do anything that is non surgical to improve my under eye area?

Doctor Answers 8

FIllers vs.Surgery for Lower Eyelid Issues (Eye Bags)

Thank you for your question and the photo. There are non-surgical options for camouflage of the contour issues and skin texture in the lower eyelid region, including fillers and resurfacing procedures.  The results of these treatments, however, may be disappointing if you have excess skin, loose eyelids, or too much fat. These issues are best addressed with a lower eyelid lift. For my patients, I recommend a procedure that uses the excess orbital fat to help fill in the hollow area and improve the contour naturally. Excess skin can also be trimmed away at this time, and resurfacing procedures (peels or laser) are sometimes a good addition in the appropriately selected patient.

Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 110 reviews

Dark circles

There are several issues that will need to be addressed.  First a transconjunctical lower blepharoplasty will remove the fat bags.  Second, excess skin will need to be tightened up thru a pinch technique and a canthopexy to tighten the outer corner of the eyelid.  Any residual wrinkles , if present, could be treated with a fractionated laser

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Non-surgical treatments for wrinkles and dark circles, but puffy eye bags require surgery

Thank you for your question.  You are asking if there are non-surgical treatments to treat dark circles and wrinkles under your eyes, and indeed there are.  However, judging from your photo alone, there are other procedures you should consider to treat your under eye area as a whole.

In my practice I would treat the two concerns you mentioned non-surgically.  I treat wrinkles under the eyes using a fractional CO2 laser.  For dark circles, I use another cutting edge procedure called platelet-rich plasma.  This procedure involves drawing your own blood, and spinning it to concentrate the healing factors (platelets).  This is then injected under the skin to stimulate collagen and new blood supply to make the skin smoother and healthier.   It is important to remember the causes of wrinkles and dark circles under your eyes, which include genetics, ethnic factors, and being around smoke.
Judging only from the picture you submitted, I can see that you have puffiness under your eyes.  This is caused by fat pockets behind the eyelids being pushed forward, which is known as lower eyelid fat prolapse.  If you want treat the whole area to achieve the best look possible, then you should consider addressing this area as well.  However, there are no non-surgical options to treat this.  What I would recommend in case is traditional lower eyelid blepharoplasty, or transconjunctival blepharoplasty.  These procedures involve going behind the eyelids to access the fat pockets, then reducing, sculpting and shaping them to a more natural contour.  When done by an experienced specialist cosmetic surgeon, these procedures are unnoticeable even in a close examination by an eye doctor.

In my over 20 years of experience as oculofacial plastic surgeon specializing in procedures to the face, I can tell you that people who treat things in isolation, and don't treat the bigger, more significant issue don't get very far.  In my practice, I would recommend:

• Treating the wrinkles with a fractional CO2 laser.
• Healing the dark circles with platelet-rich plasma.
• Undergoing tranconjunctival or lower eyelid blepharoplasty to address the puffiness under the eyes.
• A skin reduction procedure if extra skin is found in the under eye area.

As these are based solely on the photo you submitted, I recommend consulting with a specialist cosmetic surgeon before committing to any procedure.  I hope that was helpful, and thank you again for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews



The procedure that will give you the best and longer lasting results would be the blepharoplasty (eyelid lift). You do have other options but it all depends on what kind of results you are looking for.


Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon
3.3 out of 5 stars 9 reviews

Photos Show Much More Than Dark Circles

It is true that you have dark circles and wrinkles. More importantly your photos show a fairly obvious asymmetry between your eyes, some lid retraction and significant fat bags which are the main cause of your dark circles. What you have is definitely a surgical problem and could be the subtle indication of a thyroid problem. I would recommend a complete eye exam, thyroid studies and to stay away from anyone who thinks fillers is the answer.

Paul S. Howard, MD, FACS
Hoover Plastic Surgeon
5.0 out of 5 stars 7 reviews

Fillers would be disappointing

Honestly, although I love using fillers in my practice, this is not a great indication for it.

Although the easy answer is "lower eyelid blepharoplasty", your anatomy is a challenging one because you have prominent eyes, lower lid fat prolapse and wrinkling with mild eyelid retraction, and midface volume loss. All these factors make you a set up for worsening lower lid retraction if it is not addressed at the time of surgery.

What I would recommend is lower lid retraction repair with lid tightening at the time of a transconjunctival blepharoplasty [conservative fat excision],with adjunct midface fat grafting, and laser resurfacing to address the crepiness/wrinkling. This will maximize your improvement while minimizing risk of development post op lower eyelid retraction. You would also benefit from upper lid blepharoplasty [skin only]

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Under eye bags

Dear Adagietta,

  • In my experience, Restylane may not give you the results you are looking for
  • I have injected Restylane in eyes that look like yours and although there is improvement, it does not fully correct it
  • A lower blepharoplasty with a fat transfer will give you the results that you are looking for

Best regards,

Nima Shemirani

Nima Shemirani, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 74 reviews

Non-surgical treatments for under eyes

The only non-surgical treatment to help with the hollowness beneath your eyes would be to use an injectable filler.  There are a variety of options for the fillers, but my recommendation would be to use one of the hyaluronic acid fillers (Restylane, Juvederm, or Belotero).  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 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.