You’re ambitious. You don’t believe in anything less than excellence and you know you can have it all. But the dark circles under your eyes tell a different story.
The dark circles and bags under your eyes say you’re not sleeping enough, even if you are. You’re tired of people asking if you’re tired or sick. All of the concealers and creams you’ve tried have done nothing. You’re ready for a real solution with real results that last.
- How can I firm up the skin under my eyes?
Firming, tightening, and improving the skin under the eyes all comes down to stimulating the body to build more new collagen (neocollagenesis). This can be done in many different ways. At Reflections, we offer a huge variety of treatment options because each treatment works best for only a few types of people and because we know patients have preferences about downtime, number of treatments, cost, ability to go out in the sun, etc. Some of our most popular firming treatments for skin under the eyes include ThermiSmooth, microneedling with concentrated platelet therapy, and IdealEyes.
- Do under-eye fillers stretch the skin?
No, we use under-eye fillers to replace lost volume with precision - not to add or increase volume (which can stretch the skin). When done properly, filler under the eyes should restore volume that's been lost over time. Our physician injectors use specific types of filler under the eyes that swell much less than other options, and this allows us to be very precise in the amount placed, to ensure we do not over-fill the area. When following this type of technique, it should not stretch the skin. Very rarely, we have seen patients who have been injected elsewhere, where skin may have been stretched as a result of overfilling. In this case, we can dissolve the excess filler and perform a nonsurgical skin tightening treatment to try to restore skin tightness and quality.
- How do you get rid of under eye wrinkles?
Treating under-eye wrinkles in a way that creates natural results requires first understanding the cause of the wrinkles - Is it a loss of volume? Is it too much volume? Is it caused by poor skin quality (crepey skin with lots of tiny wrinkles)? Once you understand the cause, then you can get rid of under eye wrinkles by treating the source of the problem, whether that's removing excess skin, tightening and restoring the quality of the skin, restoring loss volume, or, more typically, some combination of those 3.
- Why are my under eyes so wrinkly?
The under eyes become wrinkly because the skin is moving a lot (and any creasing that's repeated in the skin will eventually lead to wrinkles), the skin is very thin and fragile to begin with, and because we often rub or stretch the skin for a myriad of reasons (allergies, makeup & its removal, etc.). For some people, wrinkles under the eyes are a normal part of their anatomy as an adult, even from a very young age. For everyone else, it's a part of natural aging.
Hollowing And Tear Troughs
Loss of normal fat pads under the eye causes deep circles and tear troughs (diagonal grooves). Some people have a natural predisposition to this, and for others it appears as part of the aging process.
The best way to fix lost volume is to replace it, either with your own fat transferred from an unwanted area to the area of missing volume (such as from your waist or midsection) or with dermal fillers that are specifically formulated to replicate normal volume in that particular area.
Thinning Of Skin & Wrinkly Excess Skin Under the Eyes
Thinning skin is skin that’s losing collagen and elastin support and will soon go from crepey to wrinkly and stretched out. These wrinkles are difficult to treat and require a skilled approach. As your skin goes from crepey to wrinkles to very loose and wrinkled, the treatment that will work best for you changes. At the beginning of this process, we find microneedling (with or without RF) offers great results at a reasonable budget and with little downtime. As the condition worsens, we need to increase the cell turnover with more aggressive skin resurfacing and might use Fraxel, RF microneedling, and/or CO2 laser resurfacing with a strong recommendation to add on concentrated micro-fat injections. Botox can be helpful at reducing wrinkles when movements are causing the wrinkles to deepen more quickly (Botox was included in the treatment protocol for the top patient in the image). ThermiSmooth or iFine (two different brands of very similar technologies) are also available options at any point in this aging process, but you may need more treatments the further along you are.
Prolapsed or Herniated Fat Pads
This is one of the most common under-eye bag causes, and it’s unfortunately very difficult to treat, since it usually looks worse when filler is added to the under-eye with this symptom present. The only 2 treatments we’ve found to effectively treat this issue are RF microneedling or surgical intervention. Occasionally, in the right patient, filler can be used to camouflage the fat pad, but because filler adds volume and this procedure does not remove any volume, it’s not appropriate for anyone who has large puffy or bulging fat pads (or who experience swelling or allergies).
Dark Discoloration Under the Eyes
Dark discoloration can be caused by shadows, hyperpigmentation, blood pooling under thin skin, or by a combination of these. Shadows are typically caused by the eye or brow structures above and are due to a lack of normal fat pad below the eye. When this is the case, filling in that lost fat with fat transfer or dermal fillers may be all you need. When skin is too thin and allows poorly circulated blood to create a dark hue, then thickening the skin and/or resolving the circulation issues is the solution. With hyperpigmentation, an unnecessary build-up of dark-colored cells (melanin) within the skin, usually in response to irritation of that area, is the cause, then hydroquinone is the best solution.
It can be very difficult to determine the underlying cause of discoloration below the eye. That’s why we offer complimentary consultations with our team of specially-trained cosmetic physicians who will help you get to the root cause of your under-eye issues.
Visible Blue Veins (blue or purple discoloration under the eyes)
Some patients, especially those with thin, fair skin have distinct individual veins that become visible under the eye. Different from large areas of discoloration, these individual blood vessels can be removed quickly and easily with laser treatment.
The treatment of choice is almost always a laser.
Hyperpigmentation (Darkness Under the Eyes)
Dark discoloration under the eyes that forms a large shape of dark or purple discoloration is hyperpigmentation. It’s much more difficult to treat than the other symptoms under the eye, and while it can be covered by makeup, most people find this darkest very frustrating. Treating this hyperpigmentation requires careful consideration of your skin type and the cause of the pigmentation, which is most often an inflammatory response. For some, this is caused by rubbing of the eyes, for others there’s just a strong genetic predisposition.
Treatments can include lasers, topical skincare, or prescription medications.
IdealEyes is the best combination of treatments for comprehensive under eye rejuvenation in a single one-time procedure. IdealEyes is Reflections’ unique approach to treating all of the underlying problems that create dark circles, wrinkles under the eyes, and under-eye bags, including loss of normal fat volume, dark discoloration, excess skin, and thin skin. This procedure is customized to the individual, and can include any and all of the following: fat transfer, concentrated platelet injections, concentrated micro-fat injections, CO2 laser, and RF microneedling in a single one-time treatment for long-lasting and natural-looking results.
- Deep Tear Troughs and Hollowness
- Dark Discoloration
- Creases and Wrinkles Under the Eyes
- Bulging Fat Pads (Puffy Eye Bags)
Dermal Fillers are a great choice for replacing lost fat under the eye1, especially as a first treatment option.
The dermal fillers that work best under the eyes are hyaluronic acid dermal fillers. Hyaluronic acid is a naturally occurring molecule within the skin that helps hold moisture within the skin’s layers. They create a smooth, natural-moving result with a very short downtime and very low risk (dissolvability increases the safety profile of these fillers).
Most patients who receive under eye fillers do not need to take time away from family, work, or social engagements after their treatment (even if they don’t want anyone to know they’ve had a treatment), which makes it the perfect fit for a busy lifestyle.
Fillers offer temporary results, so some patients will choose to have fat transfer after they’ve experienced the results filler can offer them, because fat transfer offers results that will last for decades or longer.
Fat transfer moves fat from unwanted areas, like the stomach and love handles, and transfers it to areas that could use more fat. Using your own fat makes the procedure extremely safe and the results very long-lasting.
Undereye Hollows are most often caused by a loss of normal fat pads. So replacing lost fat with your own fat creates a very natural result that looks youthful and healthy.
This procedure is performed by our board-certified plastic surgeon, Dr. Fodero.
Downtime is generally about 1-2 weeks with fat transfer to the under eyes. Swelling and bruising in the under eye is much more likely than other treatment areas – so expect visible swelling and bruising but not very much discomfort during this recovery period. You could easily work from home after a few days. The donor site is sometimes a little sore, but generally very mild and not restrictive after a day or two.
Lasers for Hyperpigmentation & Blue Veins
Lasers are the best options for clearing away poorly-draining capillaries. This is what commonly causes that dark blue or purplish tint to the undereyes. Laser treatment for this concern2 is simple and quick with almost no downtime.
There are several different lasers that can be used for this type of treatment, depending upon the individual’s skin tone, ability for downtime, and recent sun exposure.
For those with olive or darker skin tones, darkness under the eyes can be caused by irritation and rubbing. This typically has a very dark purple tint to it.
Hydroquinone is a topical medication used to reduce the melanin in an area of hyperpigmented skin3. Use of this product in the eye area should be closely monitored by a physician, as it does have the ability to thin the skin, and skin below the eye is already thin to begin with, as well as risks for creating darkness in certain patients.
This product works well for skin that is developing deep discoloration due to irritation and rubbing. However, the irritation and rubbing that caused the issue must also be addressed in order to see best results (often this is allergies, makeup, sleeping on your side, or skin rubbing against itself).
For those with fair skin and an indentation under the eyes (tear trough deformity), lifting the skin back up off of the blood vessels under the eyes can make a significant impact in dark discoloration.
This impact is caused by two effects. First, you’re removing an indentation that naturally causes a shadow. Second, you’re creating camouflage for dark blue veins under the eyes that are often just below the skin once the natural fat pad is gone.
Fat transfer and dermal fillers are used in much the same way to achieve this impact.
ThermiSmooth Eyes is a non-invasive radiofrequency treatment4 that tightens and thickens the skin around the eyes. Radiofrequency energy gently heats the skin’s deepest layers to stimulate collagen regrowth that develops naturally over a few months following the treatment. By rebuilding the internal support layers over time, this treatment offers completely natural results that are all your own, and are long-lasting. This is a favorite among our busiest clients who can’t afford downtime or prefer the discretion of a treatment without the risk of any incisions or dramatic overnight changes.
Skin Tightening & Thickening with Lasers or Microneedling
Skin thickening and tightening is a great option for those with thin skin and fine lines under their eyes and can be achieved through fractionated treatment with lasers or microneedling with various intensities. Regardless of the type of technology used, these treatments help to tighten the skin and thicken it by rebuilding the underlayer of collagen support. This creates a very natural result, which develops over time, and is long-lasting. Reflections has many different treatment options for achieving this result, including options for several lighter treatments with short downtimes or few/one treatment solutions with more significant recovery. These can be customized to fit your lifestyle, as well as treat other concerns like pigmentation and sun damage.
CO2 Laser Skin Resurfacing is our most intense ablative fractional laser5 that creates amazing, dramatic results. This surgical-grade CO2 laser treatment is a game changer and takes years off in a single treatment, by tightening and thickening the skin around the eyes. This treatment is included in the IdealEyes comprehensive under eye treatment protocol, available exclusively at Reflections.
Lower blepharoplasty (eyelid surgery) removes excess skin under the eyes and corrects any bulging fat pads below the eye. This procedure is performed under local anesthesia in our private surgical suite in under an hour, or can be booked for the hospital or outpatient surgery center under general anesthesia (if you need or so choose).
Surgery of the lower eyelid offers the best and most complete transformation, especially when there’s significant skin laxity, redundancy, or puffiness due to bulging fat pads.
RF microneedling has started to show promise as a way to reduce enlarged fat pads when set to specific settings. It does typically take a few sessions for the best results, and even then the results are less dramatic than eye surgery, but the treatment offers very little downtime and is less expensive than surgery, making it a win for the patient looking for a natural-looking boost within their budget and lifestyle preferences.
Fillers to Camouflage
For some patients, filler can be used to camouflage bulging fat pads under the eye. In these patients, the apex or highest peak of the fat pad is no higher than the surrounding tissue, meaning their issue is more a depression around the fat pad than it is a herniated or enlarged fat protrusion.
Filler is still a limited result in these patients, meaning it’s am incomplete solution that cannot offer the kind of full result a surgery can. And typically the level of correction you can achieve with filler decreases as this issue progresses, over time. Meaning it may work for a time and then stop being able to achieve the results you desire.
Deep bags or dark circles under the eyes can make you look tired and sick. Unfortunately, that’s rarely the case. So what does cause deep hollows, bags, and dark circles under the eyes?
Genetics is the most common culprit. Young and old alike, when we ask patients if their family members also suffered from dark circles, they nearly always say, yes, I saw this coming because my parents or siblings suffered from the exact same thing.
Age and time are not on our side when it comes to the under-eye area. The face loses fat as we age, and one of the most noticeable places this shows up is under the eyes. When fat first starts to disappear, you’ll start to see a small semi-circle hollow develop below the eye. As fat pads that support the cheek start to wither away, this crescent turns into a deeper diagonal groove that starts at the inner eye and cuts down across the upper cheek.
Allergies are another common cause of undereye puffiness and discoloration. Why? Because allergies cause inflammation and swelling which can cause circulation problems. This often leads to unoxygenated blood pooling in the capillaries below the eyes, and with the thin skin in this area, that blood creates a dark blue or purple tint to the undereye. Swelling from inflammation inside the sinuses or from eye irritation causes puffiness. Constant rubbing of this area can actually lead to hyperpigmentation and faster loss of normal fat pads under the eyes. Managing any allergy symptoms is an important step to creating a youthful undereye, but allergy sufferers will also want to take steps to undo the damage to the undereye area after allergies have been managed.
First, Reflections Center offers free consultations with physicians and treatments only performed by physicians. The under eyes are a difficult-to-treat area because there is so much variety in anatomy and causes of these concerns, so you truly can’t expect a one-size-fits-all approach to work well for this part of the face, and creating a plan that takes your individual anatomy into account requires the kind of anatomy training only physicians receive, and executing on that plan to create natural-looking results requires skill that only come from years of experience (and each of our physicians have at least 3 years of experience performing cosmetic treatments, currently – with most closer to a decade, or 2).
Second, we have the technologies required to treat all kinds of under eyes, with the best-in-class option for their individual needs. Under eyes can be treated with all kinds of lasers (CO2, Q-Switched, Yag, etc.), microneedling with or without RF, plastic surgery, fat transfer, regenerative cosmetic procedures, filler, botox, biostimulatory fillers, and all kinds of collagen-induction therapies (ThermiSmooth, Sofwave, Ultherapy, Thermage, etc.) – and we own all of these and more! Our practice is well-known for having every proven technology available because this investment means we almost always have the very best option for each and every patient.
- What is the best product for under-eye bags?
These are the best products for under-eye bags:
1. Retinol or chemical peels (with physician supervision and Rx strength) can be used to tighten and thicken skin in the under-eye area, and these strong resurfacing chemicals are really the only skincare products that can reverse damage in this area.
2. Allergy Medicines – if you’ve got puffiness and itchy eyes, the culprit could be allergies! Try an OTC Zyrtec or Claritin to see if this helps.
3. Products with caffeine or cold medicine can help temporarily reduce swelling, assuming the issue is water-related and not fat pad herniation.
4. Hydroquinone and other skin lighteners work for those with dark pigmentation under their eyes (although do seek a doctor’s opinion first because usually darkness under the eyes is actually very thin skin with blood vessels showing through it – and lightening agents will not help, but could hurt thin skin)
5. Botox, fillers, microneedling, lasers, regenerative cosmetic treatments, and/or surgery – truly, this is what most people need to achieve their goals.
- Do fillers help under eye bags?
Yes, when the issue is that you have areas of indentation, fillers work wonderfully to correct under eye bags and dark circles.
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- Sharad, Jaishree: Dermal Fillers for the Treatment of Tear Trough Deformity: a Review of Anatomy, Teatment Tehniques, and Their Outcomes; Journal of Cutaneous and Aesthetic Surgery; 2012 October; 5(4): 229-238.
- Metelitsa A, Rohrer T, and Arndt K; Laser and Light Therapy for Cutaneous Hyperpigmentation; www.uptodate.com. 2019 August.
- Spencer, Malcolm; Topical Use of Hydroquinone for Depigmentation; JAMA. (n/d): 194(9): 962-964.
- Goldberg, David; Ablative Laser Resurfacing for Skin Rejuvneation; www.uptodate.com. 2019 June.
Dr. Mitchell Chasin built Reflections Center for skin & body as a place where physicians specializing in cosmetic medicine could focus on helping empower patients to feel their most beautiful. Dr. Chasin believes strongly that the best cosmetic physicians are those who are dedicated to mastering their craft through continuing education and collaboration with the industry’s top doctors.