Under Eye Hollowing and Dark Circles Recommendation?

i had a facelift in mar 2008 but i did not have my eyes done as i had a browlift that took care of the uppers but since i had my undereyes done 15 yrs ago i have hollowing. Do you think i would benefit from juvederm under my eyes? i have always had dark circles as well. would that help? i would prefer not to have any more surgery.

Doctor Answers 10

Under Eye Hollows and Dark Circles Need Fat Graft for Permanent Correction

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Thank you for your question. I do understand your wish to avoid surgery. Filler injections such as Restylane do work only when injected by an expert who understands eyelid anatomy.

Many times I see patients who have had filler injections and feel their dark circles are worse. This is because the filler was injected too superficially and the eyelid muscle squeezed the filler out of the dark circle into the area below the dark circle. This worsens the shadow and makes the dark circle worse.

The transconjunctival arcus marginalis release and fat grafting is a permanent solution. This is not fat injection or fat transfer. Open grafting places a whole piece of fat into the depression and survival of the graft is better than with injected fat.

Be sure to see an expert a Plastic Surgeon who is experienced in eyelid surgery whether you decide to have a filler or surgery.


Juvederm works well

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In my experience, using conservative amounts of Juvederm (i.e. 0.1 cc/tear trough) just above the level of the bone in a serial point technique works quite well for hollowing of the lower eyelids. It will not change your skin color, unless the darkness is related to the lighting/shadowing because of the hollow. The treatment takes about fifteen minutes and just requires icing for preparation. You can have slight bruising for a couple days though not frequently. It must be done properly, though, by an experienced injector as improperly placed material will look puffy and would then need to be "dissolved" using hyaluronidase injections.

Best wishes,

Dr. Ahn

Min S. Ahn, MD, FACS
Westborough Facial Plastic Surgeon
4.6 out of 5 stars 35 reviews

Juvederm for undereye circles

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For patients whose goal is to avoid surgery, Juvederm or Restylane for undereye circles is a fine treatment. It has become routine in many practices.

Patient should be aware of the chance for swelling around the sensitive periorbital tissues with hyaluronic acids, and of the temporary nature of the treatments.

For patients wanting more permanent results, cheeklifts with placement of autologous grafts (fat injection or LiveFill) are also options that achieve more permanent results. This may also be appropriate (for the patient wanting surgery of course) if the eye shape has changed after a previous blepharoplasty and needs to be restored to a more normal configuration.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Juvederm for the hollow and bleaching cream for the dark

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A common problem, difficult to treat.

Lower eyelid "bags" are multifactorial. Causes are fat pockets, heredity, age, loose skin and tissues and discoloration from thin skin with hypervascularity, sun damage pigmentation and again, heredity.

Multiple surgical and non-surgical treatments may be indicated as with blepharoplasty and/or fat repositioning, filling hollows with fillers such as Juvederm, chemical peels and/or IPL/minimally ablative type laser peels, and finally various bleaching creams, sunblock and continued proper skin care.

As you had lower blepharoplasty in the past, one of the concequences can be a relative "hollow" from fat removal, in which case non-surgical treatment as with a filler can be a nice treatment.

David J. Levens, MD
Coral Springs Plastic Surgeon
5.0 out of 5 stars 79 reviews

I prefer fat grafting to correct under eye hollows and dark circles

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The use of fillers to correct contour deformities of the area around the eye is a good technique as long it is done by a surgeon who is familiar with the anatomy of this sensitive area. It is easy to inject a filler but when the injection is close to the eye it should be taken very seriously.

Excellent results could be acheived - moderation is the key. Start with Restylane to give the idea of the correction needed.

My personal preference is fat grafting; it lasts longer and if used correctly will provide a natural correction.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

Probably the answer is "yes"

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Old fashioned lower lid surgery often took too much fat out of the eyelids leaving patients looking hollow and tired with dark circles years later. Restylane is an excellent way to improve this volume loss in many cases. Seek the consultation of an excellent plastic surgeon and see if you are a candidate!

How to treat dark circles under the eyes.

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First of all one has to determine the CAUSE of dark circle. In most cases this is racial (I have them as well), in some cases, it is due to deep tear troughs, in others a combination of PIH or skin hyper pigmentation due to eczema, and in many cases a combination of factors.

In the US, we prefer Restylane in this area, however in Australia, Restylane and JUVEDERM VOLBELLA can be used. I do place the filler deep- namely on bone, this reduces the chances of a Tyndall effect (blue tinge).

Other ways to treat dark circles under the eyes include -

1. Treat any skin irritation - namely simplify your skin care regime- use a good eye cream
2. Low dose Q switch lasers
3, Microneedling and PRP
4. Low strength HQ creams.

Even with multiple treatment methods, dark circles can only be reduced, and not totally eliminated. Realistic expectations are crucial in treatment of this problem.

All the best
Dr Davin Lim
Laser and aesthetic dermatologist
Brisbane, Australia.

Fillers for the hollowing and IPL for the dark circles

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I like platelet rich plasma and/or HA's, such as Juviderm for under the eye treatments. Hollow areas can be filled and bags camouflaged. Juviderm or restylane are in common use for these problems, which testifies to the effectiveness of the fillers.  

Along with the eyelid injections, the injector needs to take into consideration the area of the cheek, as a cheek that is fallen increases the appearance of the eyelid bag.  Many consider the baggy eyelid to be a "pot belly" and the cheek that has dropped to be "fallen jeans".  So aging of the eye and the area below the eye (the so-called "periocular area") can be characterized as a "pot belly over fallen jeans".  

Platelet rich plasma is effective and there are no reports of blindness using it (a rare problem with fat and other fillers). It can also help rejuvenate the eyelid skin and diminish wrinkles.   Bruising with fillers can be diminished by using a blunt needle for the injections rather than a sharp one.

The HA's are approved for correction of wrinkles and folds, but not for volume replacement in the eyelids, so all filling of these areas is "off label".  

Intense Pulse Light devices can also be helpful for the treatment of dark circles, in association with pigment reduction creams.  It is important to differentiate whether the dark circles are hemosiderin or melanin based. It is also important to determine whether the pigment is deep or superficial.  A physician can use a "wood's light" to help determine this. Of course, the eye must be protected when using the IPL device, as, should the pigment be deep, a "deep IPL" treatment may be useful.  

Gregory S. Keller, MD, FACS
Santa Barbara Facial Plastic Surgeon
4.9 out of 5 stars 15 reviews

Juvederm can improve under eye hollowing

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Juvederm and Restylane, when injected judiciously, can improve the "hollowing" of the lower eyelid region. The material should be placed in a deep plane (under the muscle), or it will appear bluish.

There are many potential causes, however, of dark circles. If the appearance of dark circles is due to loss of soft tissue of the lower eyelid region, then injection of filler will help.

The appearance of dark circles though can be due to several causes including allergy-related venous congestion, an inherited or acquired pigmentary problem and even small capillaries (blood vessels) can contribute significantly to the appearance of dark circles.

I suggest you consult with a qualified health professional concerning these matters. Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

Hollowness of lower lids

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Facial fillers can used judiciously to fill hollowing in the lower lids and may mask some of the circle darkness.  It can also cause lumps and bumps if not used carefully.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.