3 min read

How to treat sunken eyes and dark circles: Eyelid Surgery or Fillers?

27 Apr

There are various surgical and non-surgical ways to address sunken eyes and dark circles. In this blog I’ll discuss what you can expect with lower eyelid surgery and fillers, as well as their associated risks so you can understand what’s involved. Hopefully, this will help you make a decision on which option you’d like to look into further.

Lower eyelid surgery options

Lower eyelid surgery or blepharoplasty improves the appearance of the under eye area by addressing dark circles, sunken eyes and smooth out the thin crepey skin.

Depending on the severity of the problem, the eyelid surgery has to be customised to deliver results. It involves removal of excess skin by an incision placed just under the eyelash margin. The excess fat is removed and repositioned, the Arcus Marginalis (AM) is released. The AM is the name for a localised rim of thickening, where the eyelid's orbital septum attaches to the orbital bone (the crescent shaped area under your eyes). Release of the Arcus Marginalis helps to move and remove excess fat. Lower eyelid surgery can then be combined with tear trough correction, fat grafting or a mid face lift to rejuvenate the area under the eye.

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Non surgical options

Hollow lower eyelid appearance and dark circles can be improved by increasing the volume using dermal fillers. The most commonly used dermal fillers are made up of Hyaluronic acid (brands such as Restylane, Juvederm or Belotero) which provide a short to medium term (9-12 months) solution.

Under eye dermal fillers represent the best current method of treating dark circles and is now recommended as the first line of treatment ahead of laser or eyelid surgery.

The risks with fillers

With injecting anything into your body there will always be associated risks. It’s important to do your research and be informed on what could happen, so you are prepared to deal with it and treat it. The potential complications from fillers can include bleeding, bruising, lump formation and infection. In some cases permanent damage to lower eyelid and facial skin is reported, however that is not the norm. Blindness and loss of vision has been reported as a complication, fortunately it is extremely rare. Many plastic surgeons recommend hyaluronic acid dermal fillers for this delicate area.

Another filler option is Radiesse, a more permanent filler. Although Radiesse has been used successfully, the risks are greater. A highly experienced doctor might be comfortable with this product, but you should research this option extensively before proceeding.

Can you use your own fat as filler?

Some plastic surgeons recommend fat transfer as a good permanent solution for addressing these problems in the under eye area. A fat transfer will have longer lasting affects, averaging 2-3 years, and looks full and natural. Ultimately it is safer to use your own body's fat, however there are associated risks, including permanent lumpiness that is difficult to correct.

You should find a plastic surgeon with extensive experience in lower eyelid surgery as well as treating that area non-surgically – they will be your best option to advise you on the most suitable solution for you. The lower eyelid area is delicate, so surgeon credentials, experience, and photos showing great results are critical for you to get the outcome you want. Don’t be afraid to see more than one surgeon for a consult if you don’t feel comfortable with the first doctor you see.

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Topics: Eyelids
Dr Naveen Somia MBBS, PhD, FRACS

Written by Dr Naveen Somia MBBS, PhD, FRACS

Dr. Naveen Somia is a Sydney Plastic Surgeon who listens to his patients, understands their problems and works alongside them to help achieve their aesthetic goals by applying his skills and years of experience in Plastic and Cosmetic Surgery. A published author on Plastic and Cosmetic Surgery, Naveen’s blog is aimed at helping you make the right choices and stay safe in your quest to look your personal best.