Best Treatment for Under Eye Hollows & Dark Circles? (photo)

I have under eye hollows as well as dark purple circles within the hollows that have become more prominent every year. I've always had the under eye hollows, which progressively look more sunken. I'm tired of constantly looking tired. I've read about Restylane being a good option for this area, but is it the best treatment for my situation? What are my other options? If I received the Restylane filler treatment, would it help remove the dark circles too?

Doctor Answers 4

The likely causes of your dark circles, and improving the skin quality with platelet-rich plasma and adding volume using fillers

Dark circles are caused by several factors including heredity and ethnicity. People who have an Indian and Arabian origin will genetically have pigmentation dark circles. The absence of pigment or the thinness and quality of skin may also cause dark circles because the reddish hue of the muscle and the bluish tint of the blood vessels are seen through the thinness of the skin. Smoking and sun exposure can also aggravate the darkening and thinning of skin.

In the cosmetic industry, fillers are used to fill-in the hollowness under the eyes. However, it cannot reduce the dark circles completely. A condition called lower eyelid fat prolapse also contributes to the appearance of hollow eyes. This condition is a bulge in the inner aspect of the eyes which makes it look puffy.

In conditions like these, a combination approach is more suitable to address all these problems. For the lower eyelid fat prolapse, I would recommend a transconjunctival blepharoplasty. This procedure is addressing the fat pockets that are bulging from the inside of the eyelid. I also routinely combine that procedure with the use of platelet-rich plasma and fractional CO2 laser. Platelet-rich plasma is derived from your own blood by doing a typical blood draw, then concentrate the platelets from the blood. These platelets stimulate the formation of collagen for better healing of the skin. If combined with fractional CO2 laser, more collagen is stimulated and generated with the use of thermal energy.

To reduce the accentuation of the hollowness in the tear trough area, I use a hyaluronic acid filler called Restylane. I have also discovered that if used in combination with platelet-rich plasma, it creates volume and a healthy look. However, hyaluronic acid eventually breaks down and the application has to be repeated.

I suggest that you meet with an experienced eye specialist for a proper examination and evaluation who does a lot of cosmetic work. Find someone who is familiar with cosmetic eye surgery, injectables and improvement of under eye hollowing and learn more about your options to address your problems.  I hope that was helpful, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Properly done, you will be thrilled with Restylane under the eyes.

You do appear to have herniated lower eyelid fat for which the traditional treatment is arcus marginalis release, a variation on transconjunctival lower blepharoplasty, a surgery.  However, there is no reason not to have the area filled with Restylane instead.  Please bear in mind that you are asking someone to sculpt your face.  Skill and artistry matters.  You are looking for someone who devotes a considerable part of their practice to performing this service.  Because it may be necessary to have the service adjusted, it is best to see someone who is easy to get to and does not work far from where you live and work.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Non surgical undereye treatment - Los Angeles

I treat undereye circles with Melarase creams, MelaPeel, and laser skin resurfacing using the DEKA fractional co2 laser. Raffy Karamanoukian Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Need a lower eyelid blepharoplasty

You would be a good candidate for a lower eyelid blepharoplasty with repositioning of the fat to fill in the tear trough zone, tightening of the orbicularis muscle and resuspension of the malar or cheek fat pad.  You will be able to make the appearance of the dark circles better but will not make them disappear.  I do not think an injectable will be of any benefit to you.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 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.