Age 27. Dark under eyes - What are my treatment options? (photo)

Question

looking for some guidance with my under eyes. My eyes have been dark since I came out of the womb, so it’s always been my biggest insecurity. i dont care about fine lines & wrinkles, my biggest concern is the color of my skin. Just off of these photos, what would you recommend? Treatments I’ve tried: -Under eye filler (never again!) -PRP/PRF injections -ResurFX laser (during the prp session) Looking for any recs: Co2, PicoSure, fat transfer, hydroquinone goal: confident w/ no concealer!

Jonghyun Hong, MD · Answer

Hello,
This is Dr. Hong from Seoul, Korea. After reviewing your picture, I can confirm that your condition appears to be genetic, but it is treatable, though achieving 100% improvement is difficult.
The issue you’re experiencing stems from three factors:
1. Vascular (capillaries and veins)2. Fat pads (loss of volume or dislocation)3. Thin skin (skin color or texture)These three factors require a combination of treatments to achieve the best result. Here's a breakdown of the treatment options:
1.Vascular Treatment: For visible capillaries and veins, treatments like V-Beam Prima or Excel V laser provide excellent results in reducing vascular visibility.
2. Fat Pad Loss or Displacement: Fat pad loss or dislocation, a common issue in Korea, can be effectively treated through under-eye fat repositioning&mdash;a minimally invasive procedure.
3. Skin Color: Addressing skin color can be more challenging. Toning lasers are effective for treating pigmentation caused by melanin (e.g., freckles), but they are less effective for inborn dark skin or areas that have darkened due to friction (such as the elbows or other sensitive areas). Procedures like chemical peels and CO2 lasers are not recommended, as they can thin the skin further and potentially darken it.
By focusing on the two more treatable factors&mdash;vascular issues and fat pad repositioning&mdash;you can achieve significantly noticeable improvements.
I hope this information helps guide you in making the best decision for your treatment.
Warm regards,Dr. Hong

Anna Chacon, MD, FAAD · Answer

Addressing dark under-eye circles can be challenging, especially when they have been a longstanding concern. Based on your description and previous treatments, here are some options to consider:

Topical Treatments: While you mentioned hydroquinone, which is typically used for hyperpigmentation, other topical treatments like vitamin C, retinoids, or niacinamide could help improve skin brightness and texture over time.

Chemical Peels: Mild chemical peels can help enhance skin tone and texture by exfoliating the top layers of the skin. Peels containing glycolic acid or lactic acid may be beneficial for under-eye pigmentation.

Laser Treatments: Since you have tried ResurFX, you might consider other laser options. PicoSure is known for treating pigmentation and could be worth discussing with your dermatologist. CO2 laser is more aggressive and can help with skin resurfacing, but it involves more downtime.

Fat Transfer: This procedure can add volume and potentially improve the appearance of dark circles by reducing hollowness, which can accentuate darkness.

Microneedling with Radiofrequency: This treatment can help improve skin texture and tone, and when combined with radiofrequency, it can stimulate collagen production, potentially reducing the appearance of dark circles.

Lifestyle and Skincare Adjustments: Ensure you are maintaining a good skincare routine, staying hydrated, getting adequate sleep, and protecting your skin from the sun with a broad-spectrum sunscreen.

Consultation with a Specialist: Given your experience with previous treatments, a consultation with a board-certified dermatologist or cosmetic surgeon who specializes in under-eye treatments would provide personalized recommendations based on your skin type and goals.

It's important to discuss these options with a qualified professional who can tailor a treatment plan to your specific needs and evaluate the potential risks and benefits.

Camille Cash, MD · Answer

The condition that you have is genetic but it can be treated.  If you were unhappy with undereye fillers you can consider fat grafting which would give a more permanent solution to under eye hollows.  Topical treatments used consistently can also improve the area.  Visit with an aesthetician at a med spa for a skin evaluation.

Leonard Grossman, MD · Answer

As a rule, the condition that you have was inherited from your father. The dark circles, if it’s pigmentation will not be removed by any means. However, what makes them look a lot worse is the fact that you have very hollow lower eyelids. What you need to consider is fat grafting. In the right hands fat grafting produces extremely natural and permanent results. I hope this helps and good luck from Leonard Grossman M.D. organic Plastic Surgery.

Berat Cigdem, MD - Account Suspended · Answer

I believe should be the first step before starting any treatment for dark under eyes. Ensuring it’s within the normal range is crucial for other treatments to be effective.

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