What is the Best Procedure for Sunken Eyes and Dark Circles? (photo)

Hi, My lower eyes seem to be sunken accompanied by dark circles. I'm trying to determine if transconjunctival fat transfer is a better solution versus using fillers? An online consultation advised eye bag repositioning and dissolvable stitches inside the eye and a stitch on each cheek to keep the fat in place. Is the stitch on the cheek normal procedure? Thanks for the help!

Doctor Answers 5

Lower Lid Bags, Sunken Eyes, & Dark Circles Respond Well To Volumizing Fillers

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What is best for any individual is frankly best determined by an in-the-flesh consultation. In general terms, however, lower lid bags, hollows, sunken eyes, and dark circles respond well to the injection of volumizing fillers appropriately placed and "molded" into place.

Many of the changes we typically encounter in the lower lids with the passage of time--namely tear trough deformities, hollows and bags,  result from shrinkage, shriveling, and a downward descent of the once robust, heart-shaped fat pad that sat immediately under the lower lids and extended out toward the temples, inward toward the root of the nose, and downward about half-way to the angles of the mouth. The loss of this volume and its downward displacement  in the direction of the jaw (due to weakening of the supporting ligaments and the downward pull of gravity) elongates the lower lid to several times its narrow youthful width and leaves it somewhat sunken. In addition, like a balloon having lost its air after being fully inflated for a long while, the skin of the lower eyelid fails to snap back to its youthful smoothness, and instead remains crinkled and baggy.

Today, we can attempt to address these problems nonsurgically with the injection of fillers and volumizing agents to restore the volume to the lower lids and recontour them, mask the bags, and diminish the darkish discoloration.

A variety of have been tried for these purposes.  My personal favorites for dealing with tear troughs--for providing overally smoothness, shape and lift-- are the recently approved Belotero Balance and Restylane L. When more cheek support and buttressing are needed for the lower eyelid, the upper inner cheek immediately below may be supplemented with with Perlane L, known for its lifting capacity. 

In my experience, while more prominent bagging may be improved considerably with this approach, some degree pf bagging typically persists following treatment. On the other hand, for mild to moderate bags, it usually takes about five minutes to treat each lower lid with immediate that typically evoke a "Wow!" response from  patients when they look in the mirror.

While minimal bruising, tenderness, swelling and redness may occur following treatment in this delicate region, these are usually temporary and disappear spontaneously within one to seven days. Most people can return to work or social activities immediately or the following day and coverup may be used if desired.


New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews


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Looking at the photo you sent in it appears that you have volume loss in the tear trough region.  Typically you can obtain a significant improvement by filling the tear trough with Restylane. This is performed in the office.  As with all procedures there are some associated risks.  Although performed by multiple physicians on a relatively routine basis it should be noted that this is an FDA "off label" use of Restylane.

If you decide to have this performed, would suggest that you see a physician who has experience with this technique.

Paul Carniol, MD
Summit Facial Plastic Surgeon
5.0 out of 5 stars 8 reviews

Under eye hollows

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HI, you should consider some type of filler under the eyes, whether its a 'permanent' or temporary one, other options would be to consider laser resurfacing of the skin under the eyes.

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 104 reviews

Dark circles under eyes

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Based on your photo, I would recommend Restylane injections under your eyes. In my opinion Restylane is much more predictable than fat transfer in the under eye area, but other doctors will have different opinions on this. I try to help patients achieve their goals in the least invasive manner possible.  Many times surgery is the best option, but I suspect you would do great with filler injections in your lower eyelids and upper cheeks to help blend the eyelid-cheek junction.

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
4.9 out of 5 stars 182 reviews

What can be done with dark circle under the eyes.

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This is mostly a shadow in the tear through area and the groove between the eyelid and cheeks. photo does not show a lot eyelid fat bulging. You seem young. Restylane is a good option and in that location it lasts longer. I use a blunt needle for this injection that makes the procedure almost painless and there is no bruising. This is the safer way to do these injections

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.