Dark undereye circles with deep set eyes, hollowing of the year trough - PRP, fillers, or just stick with makeup? (Photo)

Hi. I've had very deep set eyes and dark circles since childhood, though they've worsened with age (42) as my tear troughs have hollowed and skin thinned. My concern is that fillers may just make me look puffy since I already have extremely high cheekbones and full cheeks. Am I better off just leaving them alone, or would platelet rich plasma or other treatment possibly help me? I've attached pictures from multiple angles with and without makeup. Thanks!

Doctor Answers 3

Fillers for the Tear Trough vs PRP

This is an interesting question since it highlights the confusion around PRP as well as fillers for this area.
First, thanks for providing photos as this helps formulating a specific answer. Your concern is something we seem to see on an almost daily basis these days. The dark under your eyes is caused, in large part, by the shadow of the hollow. Unfortunately, this will get worse as you “mature” and loose more volume in this area. It is also due to thinning of the skin in this area and as a result you can now see the blood vessels that are just under the skin and contributing to the blue hue.

Make up will help but filler is your best alternative.

PRP is really just filler is really just your blood that has had the red cells removed. It is used for many therapies but it will not help with filling this area. There is a filler that is made from your blood in which the platelet rich protein or PRP is used to create filler. This will work but it only last about 2 years and will not thicken your skin or tissue to hide the blood vessels that are showing through the thinning skin.

What we find the best is the long term filler, Bellafill or Artefill. It can be air brushed just under the skin to get exactly the correction you are looking for and completely remove the hollow. In addition, the PMMA beads in this filler act to thicken the skin to help with the blue. It has been shown to last at least 5 years and we have many patients who are still very happy with their correction 8 years later.

I have added a link to some before and after photos that may help you.

I hope that helps.

Best regards.


Kirkland Plastic Surgeon
4.9 out of 5 stars 56 reviews

Your concerns are...

Your concerns are valid:  you have mild hollowing at the tear trough [eye socket hollow] with mild wrinkling.
Judicious fillers in addition to periocular laser resurfacing [conservative] would give you a nice result.

An in person consultation is very important to assess your eyelid tone. You seem to have prominent eyes and in some photos your lower lids seem to be a little low [retraction]. This may be due to the angle of the photography, but its a feature that needs to be assessed if laser resurfacing is considered.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 32 reviews

Dark undereye circles with deep set eyes, hollowing of the year trough - PRP, fillers, or just stick with makeup?

There are many reasons for dark circles besides just dark pigment in the tissue which include bulging of the lower lid fat pads, which are unrelated to weight, and a deficiency of fat below the fat fads, called a tear trough. Most expert experienced artistic plastic surgeons have a variety of procedures at their disposal to produce excellent cosmetic results in the appropriately selected patient: temporary fillers like Restylane, long-lasting micro-fat grafts, blepharoplasties, and combinations of procedures.There is no one best procedure. Each has benefits and potential drawbacks. There is often a limit of what can be achieved with the darkness, depending on its anatomical cause.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.