Options To Fill Tear Trough, To Change Tired Look and Eye Bags? (photo)

I have dark circles below my eyes which have developed in the last few years, which make me look tired all the time. I would like to know if it's possible to get rid of them, and what procedure would be the best.

Doctor Answers 7

Filler vs fat removal

You clearly have post-septal fat herniation.  Instead of camouflaging this with fillers, I would recommend removal of the fat via anterior or posterior lid approaches. 

Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Options to fill dark circles under eyes

You appear to be a great candidate for under eye improvement via tear trough filling. Filling the tear trough is extremely technique-sensitive; visit a surgeon who fills at least 2-3 patient tear troughs per day!

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 199 reviews

How do I treat my tired looking eyes

I think that you have two options. The first option would be an injectable filler such as Restylane. This is a relatively non-invasive process that adds volume to the tear trough region as well as to the upper cheeks. Restylane typically lasts 9-12 months.

The other option would be a lower eyelid blepharoplasty. This would entail removing fat from your lower eyelids. Looking at your pictures and considering your age, I would try fillers first as I am not convinced that you have that much fat in the lower eyelids that needs to be removed.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

What to do for Tired Eyes and Bags?

Hi DD.  We would also suggest Restylane in your situation.  The procedure would involve 1-2 syringes and you may benefit if some of the product was placed in the upper cheek as well as the under eye area.  

The duration of this technique is 9-12 months, but you need to find someone that is experienced because it is a procedure that can be done poorly if not using a technique called "under the muscle".  Take a look below at the pictures for this procedure.

Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

Options To Fill Tear Trough, To Change Tired Look and Eye Bags?

Your cheeks are very flat as well.  You might consider having Perlane Cheek Augmentation along with Juvederm to the tear troughs.  I'm not convinced, from the photos, that you have enough lower eyelid fat bags to warrant a lower eyelid surgery.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

Restylane injections to tear troughs work very well.


This is technically tricky, but the results can really be gratifying.  Tiny amounts of Restylane are injected deep under the muscle.  And the results can last three years.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Options in treating the tear trough

The options for treating tear troughs are either minimally invasive such as fillers or fat injections or surgical with lower blepharoplasty/eyelid surgery with manipulation of the fat, muscle and septum in that region to create a smoother transition from the lower eyelid and the cheek. I prefer Restylane in that region since it is less hydrophilic (water absorbing) then Juvederm and causes less swelling. In that region it may last up to two years. If for any reason you are not satisfied with the results you can dissolve the HA (hylaronic acid) with an enzyme such as Vitrase.

The surgery with repositioning of the fat and orbital septum as well as release of the origin of the obicularis Oculi muscle work well in most cases to treat the tear trough and are permanent in many cases the incision can be made inside the lower eyelid and avoid the scaring!

Till today nothing really works well to treat the dark circles which are either pigmentation or collection of hemosedrin from blood vessels in the thin skin of the eyelids!


Wish you best of luck

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.