Dark circles under eyes, skin type 4 - what can I do?

Question

22M,Skin type 4, concerned about dark circles around eyes and inferior scleral show. Procedures recommended by oculoplastic 1&2: lower eyelid retractor release and fillers. Oculoplastic 3: lower eyelid retractor release and orbital decompression. Maxillofacial: bone grafting under eye area and malar osteotomy. -7.00R and -4.50L prescription. I’m also considering fat grafting under the eyes. What shall I do?

Jason Emer, MD · Answer

At home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 or Morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Mark McRae, MD · Answer

I would be careful with any interventions in your case. All the procedures that you listed have a complication profile and I don't think they will give you a major change in scleral show or the dark circles I see under your eyes. I don't have the opportunity to examine you in person so take this advice with a large grain of salt. I think that your scleral show is within the normal range and I would not expect a significant change with retractor release. Fillers for the tear trough can be used judiciously but there are a number of issues that can come up with this procedure.I would recommend you avoid surgery based on the photos I see here. If you choose to try fillers, make sure you go to someone with experience and the ability to treat any complications that can arise. Also do not use anything permanent- hyaluronic acid based fillers best as they are mostly reversible. Fat grafting is a possibility here but again based on what I see I would avoid plastic surgery.

Dark circles under eyes, skin type 4 - what can I do?

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Dark circles under eyes, skin type 4 - what can I do?

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