Belotero Balance With A Little Radiesse Works Well Nonsurgically For Dark Circles, Tear Troughs, & Hollows Under the Eyes
Dark circles, tear troughs, and hollows,are common problems of the lower lids. It has become standard practice to treat this region with lighter weight fillers, like Juvederm or Restylane, to lift, straighten, and contour this region. Occasionally, if these fillers are inadvertently placed too superficially, a bluish discoloration related to light scattering (a phenomenon known as the Tyndall effect) can occur, which can actually make the dark circles more prominent. Belotero Balance, a newer hyaluronic acid product, has been manufactured to avoid this. I have found that the addition of a tiny amount of Radiesse, a whitish-colored filler, to the Belotero, to be an excellent nonsurgical method for lightening existing dark circles, while also treating the hollows and tear troughs. However, only an experienced, board certified aesthetic dermatology or plastic surgeon injector with expertise in treating this area should attempt injecting the very delicate under eye region..
You Have Both Non-Surgical and Surgical Options
The dark circles under your eyes can be permanently corrected with surgery or temporarily camouflaged with fillers. Surgery would require a fat-repositioning lower lid blepharoplasty to fill in the tear trough depression.
You non-surgical option would be liquid eyelift. Filler 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 result that are seeking, they can still undergo surgery. Other patient want a permenmant solution and choose to undergo surgery.
Each of these are viable options. I would carefully review the pros and cons of each procedure and decided what would be best for you.
San Juan, from your photos it looks like you have slight puffiness under your eyes associated with skin discoloration. Hydroquinones may be of benefit. Surgically I would address this with a "SOOF lift blepharoplasty" with laser resurfacing.
Dark under eye circles are usually from thin skin, with the blood vessels underneath showing through the skin. Because of this, thickening the skin and placing volume in the area can help. In addition, reducing the congestion with anti-histamines and eye creams that are hydrating and contain caffeine can also be helpful. My favorite fillers to replace volume are Restylane and Belotero. Thickening the skin can be achieved with retinoids (tretinoin, retinol, adapalene, tazarotene are examples) and with energy based devices. If there is concern for pigment changes with devices, a retinoid is a good place to start.
Dark eyelid skin color causing dark circles usually requires laser treatment
Based on your photograph I see two possible causes for your dark circles. First is the pigmented or dark color and the second is puffiness which pushes the eyelid forward and creates a shadow beneath the eyelid.
Fillers can camouflage the deep depression but permanent treatment requires an open blepharoplasty with fat grafting into the depression.
The dark color of the eyelid skin can be very difficult to treat. Fractional erbium ablative laser resurfacing can help but there will be a period of postinflammatory hyperpigmentation. A more conservative approach is the use of non-ablative fractional erbium laser resurfacing which will require at least 4 treatments and possibly 6 months to see the final result.
Darks circles have multiple causes including increased pigment, hollowness causing shadows, eyelid veins and wrinkles.
1. Eyelid pigment can be treated with bleaching eyelid products, Q-Swtiched lasers or laser resurfacing in lighter skin types. (Darker skin types may hyperpigment).
2. Hollowness can be treated by using fillers such as Restylane or Juvaderm.
3. Removing eye bags that cast a shadow below the bags can be performed with a lower eyelid blepharoplasty.
4. If veins are present, they may be removed by an expert who is experience in using the Nd:YAG laser. The Nd;YAG laser is extremely dangerous in unskilled hands but safe in the hands of an expert. This treatment requires compete protection of the eyeball with a metal eye shield while performing the procedure to avoid damage to the eye.