How do I fix undereye dark circles and hollowing?

Question

Ive gotten voluma and volbella for my undereyes, but it didn’t seem to help at all. I did one session of PRF Ez gel aswell and whilst it did look great the first day, the effects were gone the day after. My undereyes also look worse in different lighting

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and your experience — I can understand how frustrating this has been, especially after trying multiple treatments and still feeling like the area looks worse in certain lighting.

From what I see and based on what you’ve described, there are a few important factors at play:

1. Not all “dark circles” are caused by volume loss
Undereye concerns are usually a combination of:

Hollowing (tear troughs)

Thin skin with visible blood vessels

Pigmentation

Shadowing from anatomy and lighting

Fillers like Voluma and Volbella mainly address volume loss. If darkness is coming more from thin skin or vascular show-through, adding more filler often won’t improve it — and in some cases can actually make the area look heavier or uneven.

2. PRF/PRF EZ Gel results are subtle and gradual
PRF is not a true “filler.” The initial improvement you saw the first day was likely from swelling and hydration. PRF works by slowly stimulating collagen, which means:

Results are not immediate

Multiple sessions are often needed

Changes are subtle, not dramatic

So it’s very common for the area to look like it “went back” after a day or two.

3. Lighting can dramatically change how undereyes look
This area is especially sensitive to:

Overhead lighting

Side lighting

Camera flash

Shadows exaggerate hollowness, and reflective light makes thin skin look darker — which explains why your undereyes look different depending on lighting conditions.

4. More filler is usually NOT the answer
When filler doesn’t help after proper placement, adding more often increases:

Puffiness

Tyndall effect (gray/blue hue)

Irregular texture

At that point, the issue is usually skin quality and pigmentation rather than volume.

5. What actually helps in cases like this
The most effective approach is usually combination-based, not a single treatment:

Treatments that thicken and strengthen the skin

Careful management of pigmentation

Avoiding overfilling the area

In some cases, correcting prior filler if it’s contributing to shadowing

Undereye improvement is about balance, not chasing fullness.

The key takeaway
Your experience doesn’t mean treatments “failed” — it means the primary issue isn’t simple volume loss. Undereyes are one of the most complex areas of the face, and improvement often requires addressing skin quality and color, not just filling hollows.

You’re not imagining the lighting differences, and you’re not alone in this — many patients reach this exact crossroads after filler and PRF.

Raffy Karamanoukian, MD, FACS · Answer

Non-surgical options for cosmetic dermatology and plastic surgery continue to improve with time. Botox injections and Volume fillers continue to be at the forefront of cosmetic rejuvenation given their high safety profile and efficacy. Facial fillers are used to volumize areas of premature hollowness or wrinkling, whereas Botox is used to reduce hyperactive facial muscles around the eyes, forehead, and chin.

Understanding the various attributes of each filler and Botox option can be discussed in detail during your consultation in our Beverly Hills or Santa Monica offices. Rest assured that we will provide you with exceptional attention to detail and professionalism. 
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Laurie A. Casas, MD, FACS · Answer

Hi! 
What you’re describing is actually very common with under-eye concerns, and it usually means the issue isn’t simple volume loss alone.

Voluma and Volbella are HA fillers, but under the eyes they only help when the main problem is a true tear-trough hollow. If your under-eyes still look unchanged—or worse in certain lighting—it often points to other factors such as thin or translucent skin, shadowing from facial structure, mild fat prolapse, or pigmentation/vascular show-through. In those cases, filler can sit too deep or reflect light poorly, which is why lighting makes such a difference.

PRF EZ Gel temporarily improves hydration and light reflection, so it often looks great immediately, but it doesn’t provide structural correction—so the effect fading within a day or two suggests the concern is skin quality or anatomy, not something PRF alone can fix.

Citrus Aesthetics - San Diego · Answer

Under-eye dark circles and hollowing are some of the most complex concerns we treat &mdash; and they are rarely solved with a single product.
The under-eye area is influenced by multiple factors: bone structure, fat pad position, skin thickness, pigmentation, vascular show-through, and lighting. If you’ve already tried hyaluronic acid fillers like Voluma or Volbella without improvement, that tells me the issue may not be purely volume-related. In some patients, adding volume alone can even accentuate shadows depending on anatomy and light reflection.
PRF EZ Gel can improve skin quality over time, but one session typically isn’t enough to create sustained structural change. It works gradually by stimulating collagen, and results build with a series &mdash; not overnight.
When someone tells me their under-eyes look worse in certain lighting, that’s usually a clue that we’re dealing with contour irregularity, skin translucency, or pigmentation &mdash; not just hollowness.
This is where a multi-modality approach becomes essential.
Depending on your anatomy, that may include:
Careful structural support (sometimes midface support rather than direct tear trough filler)Collagen stimulation treatmentsLaser or light therapy for pigmentation or vascular discolorationSkin tightening for crepey textureStrategic dissolving if previous filler is contributing to puffiness or shadowing
The goal isn’t to “fill the dark circle.” The goal is to restore the entire midface so light reflects more evenly.
The under-eye is one of the most complex areas in aesthetics. It requires careful assessment, conservative technique, and a customized treatment plan, not a one-size-fits-all solution.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

How do I fix undereye dark circles and hollowing?

Answers (4)

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