Under Eye Dark Circles, Hollows, Bags. Tired Looking?: Treatment with Dermal Filler

 Do people say you're looking tired all the time?

Dark circles or bags under your eyes?

Then maybe a dermal filler treatment is all you need to instantly make you look well and refreshed again.

Dr Beulink is one of New Zealand's top injectors of dermal filler since 1992. Starting in those early days with Collagen, in 1996 he became the first doctor in New Zealand (and one of the very first in the world) to start using the then new hyaluronic dermal filler Restylane, now a world wide gold standard.
 

What causes dark circles under eyes? 

Dark circles under eyes are usually caused by hollowing in the "tear trough" zone due to volume loss caused by loss of fat in this area. This is usually due to age but can be present in much younger people who are genetically predisposed. The dark colour occurs because this loss of tissue allows the deeper dark purple muscle layer to show through. Often a "bag" will appear, as this loss of structure, plus loss of upper cheek volume in more severe cases, causes a loss of support to the tissue structures directly under the eye, which will then begin to bulge unsupported. The darkness is further compounded by the shadowing caused by this troughing and bagging.  
Pigmentation is usually never a contributing factor, and is why no creams will ever be of any use to help fix this problem.

Restylane Dermal Filler treatment for under eye circles.

By adding volume back into the troughs and upper cheeks, the "valleys" can be filled in to smooth out these negative contours, effectively eliminating the dark colour and shadowing, and erasing the perceived tired look. 
However, filling this area with injectables is THE most difficult of all dermal filling. It is not something you should have done by an inexperienced and unskilled doctor or nurse. Choose your injector very carefully. Due to the thinness of the tissues and skin, the area being extremely prone to bleeding and significant bruising, a tendency to swelling and the close proximity to the eye, this is "Tiger Country" to say the least! However, if done properly, this arguably produces some of the most rewarding results of any dermal filling.

Can Restylane Dermal Filler treat larger volume loss under eyes and in cheeks?

In many cases, and particularly over the age of 40 years, this loss of volume in the tear trough can become more widespread in the upper/mid face, extending further down and out along the cheeks. This more generalised volume loss in the mid face is very typical of the natural ageing process, and is why in some cases, people can look "sad", "tired", "burnt out", or "unwell". This structural volume loss type of ageing, is quite distinct from the typical wrinkles often associated with age. It is these structural changes that we all all see (but often don't realise) when someone walks into a room, and we instantly categorise them as being 20,30...70 years old, or good or bad for their age. This has nothing to do with wrinkles......we don't even see the wrinkles until the person is up close! For this type of structural ageing, the treatment essentially comes down to more volume replenishment (sometimes referred to as the Volumetric FaceLift), and to the simple maths of more filler replacement (and unfortunately more cost). If significant volumes of filler is required, then consideration should perhaps be given to the alternative of Fat Transfer.

Tear Troughs / Dark Circles Under Eyes:

How long will dermal filler under the eyes last? Typically results can last up to 12-18 months, and I have seen many cases lasting well beyond 2 years (one case that particularly springs to mind, has lasted well over 3 1/2 years and still counting!). I'm not exactly sure why this area lasts so much longer than dermal filler treatments to other parts of the face. My thoughts are that initially it probably has something to do with there being less direct mechanical stress breakdown on the filler, say as compared to around the mouth (which has probably the shortest duration of any area), but I believe that there is a bit more to it than simple mechanics. I have a hunch that its increased longevity in this area has more to do with increased stem cell activity specific to this area (I have also witnessed since 1998, improved fat transfer rates to this area for what is almost certainly the same reason). -see below for more on this

How is the treatment done and will it hurt? The treatment is done under local anaesthetic, and once anaesthetised, is completely painless. It does not hurt after the anaesthetic wears off. Treatment, however, tends to be a little bit more tedious than when treating other zones of the face, simply due to the potential fragility in this area. I incorporate an anti-bruising agent which can be seen in some of the after photos as a subtle pale effect - this is temporary only, but significantly reduces the risk of bruising and swelling (which can otherwise be a huge problem in this area). Some temporary minor bruise or welt spots can sometimes be seen, but could be covered up with foundation etc.

What about lumps? As mentioned above, this is "Tiger" country as far as fillers go. With such thin and fragile tissues, and usually being the case of attempting to recreate something out of nothing, inappropriate infiltration of filler in this area can very quickly become a "run away train scenario". I have seen numerous cases come to me with too much, too lumpy or simply the wrong filler put in. I have also read claims that lumps can simply be "pushed" or "squashed" out at a later date. This is not true, and not quite so simple. However, luckily these problems usually can be corrected, but may take a bit of fiddling around to get them right. Bottom line: chose an injector who is competent in treating this specialised area and get it right first time. For more about side effects of fillers under eyes please go to my Personal Comments section on the general Dermal Filler page.

Which filler is best: Restylane or Juvederm? Both these products are hyaluronic acid type fillers but Juvederm in recent years has been associated with reactions that do not occur with Restylane (see my Personal Comments on the general Dermal Filler page). I can only draw on my personal observations and experience, working with Restylane since 1996 and as such, I know what Restylane can do, and what it's long term effects are. Restylane as a product, is completely safe (how, where, or by who it is injected is the problem variable), and long term I have personally witnessed the tissue regeneration caused by the auto-reboot of local tissue stem cells (they love this stuff!). This is why when multiple treatments using Restylane are done over many years, the result (not the product) tends to last longer and longer each time. This positive effect of Restylane, can not be said with certainty for Juvederm. So rather than asking which filler is best, it is often far more important, to determine which injector for you is best.

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Below are just some examples of what can be achieved to rectify dark under eye circles and under eye bag problems with a small volume of dermal filler. The after photos have been taken immediately following the completion of the treatment. The dermal filler used here was Restylane; it is a forgiving natural gel which has fantastic longevity in this area.
 

Photos of before and immediately after treatment with Dermal filler for dark circles and hollows under eyes:

Instant results can be seen immediately, following the use of limited amounts of dermal filler for dark
circles and hollows under eyes. Placed correctly, typically only half a tube of filler is required on each side.

Minor bruising only (using Dr Beulink's special technique), blushing or small needle skin welts

can occur but are temporary and can be covered up with standard makeup.

Dark Circles Under Eyes as a result of a more generalised Age Related Volume Loss in Cheeks
(treatment here consists of a more global Facial Volume Replacement, The "Volumetric Face Lift")