What treatment/procedure can I have to reduce my dark circles and slight puffiness under my eyes? (photo)

I am a 28 year old woman and I am starting to notice that I am forming purplish bluish dark circles under my eyes and It it makes me look tired . I'm tired of using concealer to mask my darkness, because while it covers my dark circles it makes my puffiness more exasperated. I've used just about every kind of skin care regimen for under eye puffiness and darkness , but they don't work.I just want to find something that will deal with my concerns and make me look refreshed

Doctor Answers 5

Surgical and non-surgical options for your slightly puffy eyes. Dark circles can be treated non-surgically.

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Puffiness under the eyes is called lower eyelid fat prolapse. Lower eyelid fat prolapse is the presence of fatty pockets around the eyes that pushes forward and creates a bulge under the eyes resulting in this puffy appearance. People will assume that this is result of fatigue, allergies, or other factors like lack of sleep. They use topical treatments like creams that they buy over-the-counter. Unfortunately, that approach doesn’t work. Lower eyelid fat prolapse is a specific volume of fat that can’t be addressed with topical creams.

Discoloration under the eyes is mostly caused by genetics, especially people of Indian, Arab and African descent. These people will have some form of pigmentation under the eyes commonly called dark circles. There are times they look even darker when there is a loss of volume and are affected by external factors such as a sun exposure. The eyelid skin is very delicate and there a lot of things that can prematurely affect the quality of the skin. For a lot of people who smoke, the skin quality of the eyes looks almost gray or ashen. From a holistic approach, you can modify your habits to try to protect the skin and maximize its quality just from your own habits of diet, exercise and things that are good for your heart and skin.

After an appropriate physical exam, if there’s a slight degree of fat prolapse, the appearance can be improved by using a filler to treat the hollowness adjacent to the fat to make the bulge less obvious. In most cases scenarios, we deal with the fat prolapse with a more definitive method called transconjunctival blepharoplasty. Transconjunctival blepharoplasty means that we address the fat pockets from the inside of the eyelid. This way, there’s no external scar and we are able to reduce or reposition as appropriate. We are also able to address the fat pockets definitively for a long period of time. In our practice, it is done in local anesthesia with LITE™ IV sedation. It’s relatively minimally invasive compared to doing it in under general anesthesia. People will try non-surgical solutions, but they’ll keep having to maintain them as opposed to a surgical procedures which is more definitive.

For discoloration under the eyes and to improve the skin quality, we have been doing a lot of work with something called platelet-rich plasma (PRP). Platelet-rich plasma is the use of your own blood to get the healing and growth factors which are separated. We use your own blood to improve the circulation, the collagen and the skin quality.

When there is a hollowness issue, we have been able to combine the platelet-rich plasma with a hyaluronic acid filler such as Restylane. There is a synergistic benefit of combining PRP with hyaluronic acid to get more permanent or long-term benefit of the tissue underneath the skin. The synergy between them is that platelet-rich plasma stimulates new blood vessel growth and new collagen, while hyaluronic acid acts like a scaffold to allow this new tissue growth to occur.

Every patient has to be treated as an individual so we always customize the plan. If you were to go for lower eyelid blepharoplasty, very often we would combine it with platelet-rich plasma. If there is hollowness, then we would use platelet-rich plasma and hyaluronic acid. At this point, I would recommend that you meet with qualified specialists in cosmetic eyelid surgery. They should also have a lot of experience with: dealing with darker skin, the complexities of the different surgical procedures, and the type of procedures that are available to minimize the risk whether it’s surgical or non-surgical. I hope that was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Treatment options for lower eyelid puffiness and dark circles

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Lower eyelid surgery, filler injection and fat grafting are popular treatment options for lower eyelid dark circles and puffiness. Since they all have pros and cons, the treatment decision should be based on the severity of the puffiness, your expectation, downtime, cost, surgeon's preference, aesthetic sense, etc. In my opinion, surgery has the best chance of achieving the best and long lasting aesthetic outcome.

Eric In Choe, MD
New York Plastic Surgeon
4.6 out of 5 stars 51 reviews

Minimally invasive procedure

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There's only a small amount of prolapsing fat in your lower lid. A small amount of filler injected just below that (in the tear trough region) will soften the transition between the lower lid and the cheek area.

A local board-certified facial plastic surgeon or a general plastic surgeon can help counsel you through this decision.

William Numa, MD, FACS
Boston Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews


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Some fillers can be used off label to the under eye area. You should see several certified plastic surgeons and see what they're opinions are. Most plastic surgeons offer complimentary consultations. Minimal bruising and swelling should be expected from these types of filler injections. Good Luck! 

You have a small amount of prolapsed fat which is causing a shadow in the lower lid.

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This darker area is called the tear trough.  If you put a little filler into this area, it should help to camouflage the fat and make the area look smoother and lighter. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 31 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.