21, male, dark under eye area. Is a Tear Trough Fat Transfer right for me? (Photos)

Question

Hello, I am a young 21 year old male. I have had darkness around the under eye and tear trough area for most of my life .i I want to improve it for cosmetic reasons however I am unsure if my darkness is due to hyperpigmentation, vascular show, lack of volume / support, or a combination of reasons. I have done blood tests and I am not deficient in any critical nutrients, I do not smoke or drink, and exercise on a regular basis. My sleep quality seems to also yield no improvements to this area. Whenever I perform stretch tests with the skin under the eye (as shown in the photos) there is a reasonable improvement in the tear trough area but there is still some diffused “pigment” which makes me think I should consider an under eye fat transfer and hyperpigmentation treatment. However, I would like to know what do you think the cause is? Can it be treated? And would I even be a candidate for fat transfer to this region? Thank you!

Edwin Kwon, MD, FACS · Answer

Dark circles at a young age are very often a mix of causes rather than just one, and the stretch test you did is a helpful clue. When pulling the skin smooth makes the area look noticeably better, part of the darkness is a shadow from a hollow tear trough. The color that stays behind after stretching usually comes from pigment in the skin itself or from thin skin letting the blood vessels underneath show through.

Fat transfer can be a good option for the volume part of the problem. Placing small amounts of your own fat along the tear trough and the upper cheek fills the hollow so light no longer catches it as a shadow, and the added layer of tissue can also soften some of the bluish or purple tone from vessels showing through thin skin. I centrifuge the fat to disturb it as little as possible, which helps more of it survive, but the under eye skin is very thin, so the fat has to be placed in tiny amounts and fine layers to avoid lumps. It's also fair to expect that some fat will be reabsorbed.

What fat won't change is true pigment in the skin. That part is better treated with skin care and in-office skin treatments, and many patients do best with both approaches together. I'd encourage you to schedule a consultation with a board-certified plastic surgeon so your under eye area can be examined in good lighting and the right combination of treatments can be planned for you.

Zoran Potparic, MD · Answer

It appears that you have a condition called malar hypoplasia, small cheek bones. It is very mild in your case but sufficient to show signs of hollowness, darkness, tear trough very early in life. Augmentation with fat grafts (in your case) or cheek implants for more severe condition is appropriate treatment. Good luck.

Randal Haworth, MD, FACS · Answer

At 21, darkness that has been present most of your life is usually a mixture of factors rather than one, and sorting them out is the whole point of an exam. Your stretch test is a useful clue: the part that improves when the skin is pulled smooth points to a volume or support shadow along the tear trough, while what stays dark points to pigment in the skin or to blood vessels and muscle showing through thin eyelid skin. Fat transfer addresses only the first of these. In the right candidate it can soften the hollow and add a bit of thickness over the area, but it does nothing for true pigment, the result can be uneven if fat is placed too superficially, and some of the fat may not persist. Pigment is managed separately, usually by a dermatologist. Because the under-eye area is unforgiving, I would suggest an in-person evaluation with a board-certified surgeon experienced in delicate periorbital fat grafting before committing to anything.

21, male, dark under eye area. Is a Tear Trough Fat Transfer right for me? (Photos)

Answers (3)

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