Information about Under Eye Treatments

The under eye area is a very challenging area to treat. In addition to the technical difficulties in treating this area due to anatomic and structural considerations, the aesthetics of the eye area can be difficult to understand and agree upon. I recommend a close dialogue and open communication between the provider and the patient. The provider should accurately describe what results the provider can likely deliver and the patient can communicate what goals the patient is trying to achieve. Fortunately, with dermal fillers, preliminary results are seen immediately, and real-time feedback is encouraged during and immediately after the treatment.

Risks and Benefits of Treatment

The risks and benefits of treatment should be thoroughly discussed. The most common side effects seen after a dermal filler injection are bruising and swelling. An estimated 4% of patients experience bruising after dermal filler injection. I recommend postponing treatment if a patient has an important public event within two weeks after the treatment date. Treatment with a cannula decreases the chance of bruising and swelling, but these side effects may still occur.

Agnes RF

An additional option is Agnes RF. This procedure can shrink the fat pads under the eyes and tighten the skin. This treatment is recommended for larger fat pads. First, the Agnes RF treatment is performed to shrink the fat pads and fillers are used to touch up the remaining imperfections three to four months later.

Read the infographics below to know more about Agnes RF.

Causes of Dark Under Eye Circles

The three common causes of dark under eye circles are shadowing, skin pigmentation, and fluid retention.

• The shadowing is caused by light being blocked by adjacent tissue. This is typically due to the fact that there is volume loss under the eye that leads to a depression. The depressed area is lower than the adjacent tissue and looks darker because of shadows from the higher adjacent tissue. This cause of dark under eye circles is best treated with dermal fillers. The results are consistently very good and reproducible.

• Dark circles caused by skin pigmentation can be due to melanin or hemosiderin. Melanin is a normal pigment that is produced by melanocytes in the skin. Overproduction of melanin can be caused byirritation, hormonal, or genetic factors. If the skin pigmentation is caused by melanin, treatment with a lightening cream containing ingredients such as arbutin and hydroquinone can improve the appearance of the dark circles. Hemosiderin is a normal by-product of blood cells. If blood or fluid is retained in the under eye area for a long time, blood cells may leak into the skin and hemosiderin may be deposited. Creams that help shrink or stabilize blood vessels and prevent bruising may help prevent hemosiderin deposition. It is easy to distinguish between skin pigmentation and shadowing by gently pulling down on the under eye skin. If it is the skin that has the pigmentation, the dark skin will be pulled down.

• Fluid retention is also a common cause of dark circles under the eyes. Most of us have experience with waking up in the morning with puffy eyes. Lack of sleep, too much salt, allergies, and poor health can lead to fluid retention under the eyes. Depending on the cause, ice packs, anti-histamines, dietary changes, and life style changes can help with fluid retention.

Under Eye Treatment concerns and possible treatment options:

1. Shadowing – Filler
2. Dynamic (with movement) wrinkles – Neurotoxin (Botox)
3. Static (at rest) wrinkles, texture – Filler, Fractional CO2 laser, RF microneedling, Agnes RF
4. Spider veins, Red spots – KTP laser
5. Excess skin – Surgery, Filler, Fractional CO2 laser, RF microneedling, Agnes RF
6. Fat pads – Surgery, Camouflage with Fillers, Agnes RF
7. Dark spots, Pigmentation – Lightening creams, Fractional CO2 laser, KTP laser