Is tear trough or cheek filler suitable to treat dark under eye? (Photo)

Question

I am 30 years southAsian so I have under eye dark circle from childhood & got worse as I have recently notice some hollow underneath over time. I have visited a doctor who suggested me a tear trough while another doctor suggested me to do cheek filler as it has to lift my whole face as well. However I have already prominent cheek, I m scared of over filled, so what’s suitable for me in this case ? And for hyperpigmentation can I use hydroquinone cream under my eyes ?

Raffy Karamanoukian, MD, FACS · Answer

Dark under eye circles can make you look tired and older than you are. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of injectable fillers, fractional laser, and RF to blend out the eyelid hollowness and tighten the skin. 
Recommended Creams: Melarase Brightening Kit
MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Both tear trough filler and cheek filler are potential treatment options, but their suitability depends on your specific facial anatomy and aesthetic goals.Tear trough fillers are designed to directly address the hollowing under the eyes, which can help reduce the appearance of dark circles caused by shadows.  Cheek fillers, on the other hand, can provide lift and support to the entire mid-face, indirectly improving the appearance of the under-eye area. However, if you already have prominent cheeks and are worried about overfilling, this may not be the best option for you.In terms of addressing hyperpigmentation under the eyes, topical treatments like hydroquinone can be effective. However, the skin under the eyes is very delicate, and hydroquinone can potentially cause irritation or worsen pigmentation if not used correctly.

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.

Lexie Wang, MD · Answer

Hi! From this photo, it looks like you could handle some judicious placement of undereye filler, although definitely make sure you understand the risks associated with it and that you go to someone who is an expert injector as there are a lot of things that can go wrong with undereye filler. This should help some of the hollowing/shadowing effect. Otherwise, if it is a truly skin-related pigment issue, then HQ can help.

Robert Dale, MD · Answer

The under-eye area is very complex. Simply doing tear trough filler on its own is usually not enough. Usually some cheek augmentation is required as well. If that dark circles are caused by changes in skin pigmentation then this won't be fixed with filler. One could try an eye serum to improve the skin quality. Filler is used to fix volume deficit and sagging - it won't do anything for hyperpigmentation.

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