What to do about my under eyes - genetically hollow and darkness? (Photo)

Question

I’m 27 and have had multiple rounds of filler and PRP. This photo is from 2019 when I was 21 - after PRP - but before my last set of filler. I have genetically hollow undereyes and darkness that I am extremely insecure about. I like the volume that filler added but the discoloration still remained. I’m unsure if I should continue with more filler/PRP or find a surgical option.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns and providing such a detailed history. It’s completely understandable to feel self-conscious about under-eye hollows and darkness — this area is delicate and can be challenging to treat, especially when genetics play a role.

Here’s some guidance based on what you’ve described:

Filler for Volume:
Hyaluronic acid filler can restore volume to genetically hollow under eyes and improve the contour, which it sounds like you’ve had some success with. It can reduce the shadowing caused by the depression, making the area appear smoother and less tired.

Dark Circles and Discoloration:
Filler can help with the shadow effect caused by hollowness, but it usually does not fully correct pigmentation or vascular darkness. Treatments like PRP or laser/light-based therapies may help with skin quality and subtle improvement in color, but results vary, and it can be gradual.

Surgical Options:
For persistent hollows and significant discoloration, a lower eyelid blepharoplasty or fat transfer can sometimes offer a longer-term solution. Surgical options address both volume loss and, in some cases, the shadowing effect, though pigmentation may still need adjunctive treatments.

Combination Approach:
Many patients benefit from a combination of subtle filler, skin treatments, and occasionally surgical options if the concerns are longstanding and significant. It’s all about balancing volume, skin quality, and color while keeping results natural.

Managing Expectations:
The under-eye area is delicate, and every treatment has its limits. While filler improves the contour, darkness can be stubborn, and sometimes perfect correction isn’t possible with non-surgical methods alone. Gradual, carefully planned treatments usually give the most natural and satisfying results.

You’ve done a great job exploring options so far, and it’s completely normal to feel unsure about next steps. A thoughtful, stepwise approach — considering both non-surgical and, if desired, surgical options — often provides the best outcome while minimizing risk.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Given your history with under-eye hollowness and discoloration, it makes sense that filler and PRP helped with volume but didn’t fully address the darkness. In many people, under-eye discoloration comes from factors that fillers can’t fix—such as thin skin showing underlying muscle/vasculature, pigmentation, or tethered ligaments creating shadows. When filler is added repeatedly, it can improve volume but sometimes risks puffiness or a “muddied” look without truly correcting the color. PRP can boost skin quality but usually has limited effect on true pigmentation or vascular darkness. If your main concern now is persistent discoloration and/or volume loss, you may benefit from considering other surgical options.

Darryl J. Blinski, MD · Answer

Based on the one posted mostly blacked out photo I would recommend a virtual consultation, but would also recommend the Endo laser to the lower eyelids and half a syringe of HA filler for evenness expect feet to range from $2500 to-$3500

What to do about my under eyes - genetically hollow and darkness? (Photo)

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