A glance in the mirror tells you all you need to know: Dark circles ring your eyes, making you look tired. You may have under-eye circles for a few different reasons. It could be the result of fatigue, yes. Or seasonal allergies, especially if you tend to rub your eyes. Sun exposure may also be a factor when it comes to dark circles. But you might also have experienced some volume loss in the area under your eyes, says dermatologist Dr. Stephen Hess, MD, medical director at Center City Dermatology in Philadelphia. “That creates a shadowing effect from the concavity,” he says. “And it also means that the skin in that area is lying closer to the veins that surround the eye, and you can see a bluish-brown sort of discoloration on the skin, because the veins are now too close to the surface of the skin.” One potential solution? Fillers for dark circles. But should you try it? It depends on what the problem actually is. Here’s what you need to know.
When filler may not be the right choice for dark circles
People request fillers around their eyes all the time, but some experts aren’t too enthusiastic about the prospect of using fillers to address dark circles under the eyes. “The tear trough is an unforgiving area given the thin skin and racial variability. The best candidates are those with good skin tone and minimal skin excess,” wrote the authors of “Practical Approach and Safety of Hyaluronic Acid Fillers,” which was published in 2019 in the journal Plastic and Reconstructive Surgery—Global Open. As plastic surgeon Dr. Alan Matarasso, MD, explains, many dark circles are the result of either darker-colored pigment in the skin in that area or very thin skin under the eyes that doesn’t fully cover up the tissue underneath. “Filler is not going to help with either of those things,” says Dr. Matarasso, who is the immediate past president of the American Society of Plastic Surgeons. And he adds, “Why would you inject filler into a color?” Dr. Jason Clark, MD, a dermatologist in private practice in Atlanta, gets lots of questions about under-eye circles and the possibility of using fillers to address them. He points out that many people have spent hours staring at their images and finding flaws during Zoom calls since the COVID-19 pandemic began. But he notes that there are no FDA-approved fillers for dark under-eye circles. Plus, you have to watch out for a phenomenon called the Tyndall effect. If a hyaluronic acid filler is deposited too close to the surface of the skin, you can wind up with a bluish hue in that location. It resembles a bruise, but it doesn’t go away after a few days. In fact, it can last for months. So, what can you do if you have dark circles and you’re self-conscious about them? Dark circles can be tricky, and it’s not always easy to correct them, notes Dr. Hess. You can always try applying makeup to conceal them. It’s a very temporary solution–one that you’ll wash off at the end of the day. Another option if you have dark circles but no volume loss under your eyes isa cream to lighten the hyperpigmentation of the skin, suggests Dr. Hess. He likes a cream called K-Ox Eyes, which contains vitamin K, which helps to lighten up the discoloration. And if you have allergies or eczema that are contributing to the circles, you should definitely consult your doctor about making sure you’re getting the right treatment for both of those conditions.
Fillers can help with volume loss under the eyes
However, if you’ve experienced some volume loss in that area, a filler might help, says Dr. Clark. He uses a long, blunt-tipped cannula to deposit very small amounts of filler. “I tend to be really cautious in that area,” says Dr. Clark, who is also an adjunct assistant professor of dermatology in the Emory Department of Dermatology. “And I tend to really underfill the undereye (area) because I’ve seen so much overcorrection.” In fact, he might start with one syringe of filler but only use part of it under the eyes. (The rest can be used elsewhere on the face, if the patient so desires.) Tara Adashev, NP, a nurse practitioner who works in the practice of Neinstein Plastic Surgery in New York, agrees that it’s important to be cautious to get a balance between overfilled and underfilled in this delicate area. She prefers to use a hyaluronic acid filler known as Restylane in this area, and it typically lasts around six to eight months. But if your main problem is bags under your eyes, you might actually be happier with a blepharoplasty, which is a surgical procedure that repairs drooping upper eyelids or removes bags under your eyes or excess skin from your lower eyelids. The procedure takes about 25 minutes, and when you’re done, “you’re done for life with that,” says Dr. Matarasso. No follow-up trips to the dermatologist or plastic surgeon for more filler. As for cost, it may cost more upfront to get a blepharoplasty than to get fillers—although the cost of fillers can add up over time if you get them repeatedly. The average cost of cosmetic eyelid surgery is $4,120, according to the American Society of Plastic Surgeons. It’s possible that your insurance company might cover some of the cost if your lids impede your vision in some way. However, the Mayo Clinic notes that lower lid blepharoplasty is nearly always done for cosmetic reasons, so it probably wouldn’t be covered in that instance. Ultimately, it’s worth having a conversation with your doctor about your goals, your budget, and what you feel comfortable doing before you commit to a procedure. You want to make sure that you choose a solution that is appropriate for your problem–and that you feel good about the choice. Next up: You’ve Probably Heard About Laser Skin Resurfacing for Aging Skin, but Should You Try It? Derms Weigh In
Sources:
Blepharoplasty. Mayo Clinic.Jason Clark, MD. Clark Laser & Cosmetic Dermatology.Eyelid Surgery. American Society of Plastic Surgery.Tara Adashev, NP. Neinstein Plastic Surgery.Stephen Hess, MD. Center City Dermatology.Management of Tyndall Effect. The Journal of Clinical and Aesthetic Dermatology.Alan Matarasso, MD. Past President of American Society of Plastic Surgeons.Practical Approach and Safety of Hyaluronic Acid Fillers. journal Plastic and Reconstructive Surgery - Global Open.
