Under eye dark circles and under eye bags can be due to many different reasons. Each patient needs to be evaluated for their specific cause for their problem. The following is a list of several different contributing factors for under eye dark circles or bags:

1. Presence of an under eye fat bulge or orbital fat
2. Hollowness of the superior cheek or groove
3. deficiency of the inferior orbital rim (the cheek bone supporting your eyeball)
4. Hyperpigmentation of the lower eyelid skin
5. Thin under eye skin with visibility of underlying veins and muscle
6. Overly dark under eye muscle
7. Increased vascularity of under eyelid skin and fragile leaking veins

Several of these factors might be present at the same time and can contribute to the appearance of under eye dark circles or bags. These need to be identified and treated accordingly.

Sometimes filler needs to be placed deeper and sometimes more superficially. Some of the above factors have yet to have a dependable treatment. During your consultation we will go over all the factors that are contributing to your problem and what can or can't be addressed.

The end result should be natural looking without appearance of lumps or problems.

By Dr. Gal Aharonov

My filler of choice around the eyes is restylane for a number of reasons.

1. Restylane is soft and pliable and can be dissolved if there is ever an issue.
2. Unlike Juvederm which can fluctuate in swelling pretty dramatically from one day to the other, restylane has much less of these fluctuations and hence gives a more uniform and predictable result. When injecting filler around the eyes, even a little bit of change in swelling can make a dramatic difference. Juvederm tends to have many more of these fluctuations than restylane. This is not as big of a deal when injecting to the lips or laugh lines, but around the eyes it can make a big difference.
3. I would urge you to not have radiesse injected close to the eyes. I use radiesse a lot and think it is very nice for temples, cheeks, jawlines, hands, etc. It is way too hard and unpredictable around the eyes.

Restylane injections around the eyes can be one of the most cost effective ways to improve your appearance. It can make a dramatic difference in the way you look, and it tends to last a very long time. For example, restylane injected to the upper eyelids and brows can last upwards of 2 years or more. Restylane injection to the lower eyelids tends to last a little less: about a year or so. Even after a year you might need a fraction of what you needed the first time.

Restylane, and fillers in general, tend to last much longer around the eyes than around the mouth. If you had restylane or juvederm injected in your lips and it only lasted less than 6 months, do not think that it will last such a short amount around your eyes. It will still have a long lasting result.

what about lumps? Lumps from restylane injection around the eyes is a function of technique. If you had lumps from restylane injection it does not mean that you have a reaction to restylane or that you will have the same issue in the future. It just means that the technique used was not perfect. You should not have lumps after treatment! Even if lumps do occur, they can usually be treated with gentle massage, or be dissolved by injection of hyalunonidase.

Dark circles under the eyes can be due to many reasons. Look at the eyelid page for more information. So do those eye creams really work? Some people's only or main issue is overly thin eyelid skin, where the darkness is due to the fact that you can see the underlying dark and veiny muscle, through the practically translucent skin. Our eyelid skin (as well as the rest of the skin in our body) gets thinner as we age. Some to a greater degree than others. As the eyelid skin thinks, it is almost like a piece of tissue paper--see through. The underlying muscle is dark and blue--and in some people darker than in others.

The principle, in theory, of some of these eye creams is to thicken the dermis to make it less see through. This is done by adding active ingredients which tend to make the skin swell either via irritation or through increased hydration.

Some of these creams actually work, if this is your main issue. Which cream might work for you? That is hard to predict. You might have to go through a period of trial and error. Start with the cheaper ones, because cheaper doesn't always mean not as good when it comes to these skin care products.

If your under eye dark circles are due to other reasons like excessive fat, loss of fat in the upper cheek, or what is called the tear trough area, these creams are probably not going to help much if at all.