As an oculoplastic surgeon I often get asked the question, “What do I do about my under eye dark circles?” While there is not a “one size fits all” answer, here I hope to expand your understanding of the problem.
For most, dark under eye circles are caused by the contour of the lower eyelid. As we age, the fat and collagen in the lower eyelid shift, which can cause a hollow depression. This depression in the lower lid can cause overhead light to cast a shadow that appears as a dark circle.
A good way to see if your dark circles are from a contour problem is to take a flashlight and shine the light from below. If the darkness improves then you most likely have a contour issue.
For some, the under eye skin is more has more pigmentation and this is what causes the dark appearance. Also as we age the skin of the eyelid becomes thinner, allowing the darkness of deeper structures in the eyelid to show through and give a dark hue.
There are many great solutions to lower eyelid hollows. Filler is a great option for patients in their 20s to early 40s who have a small hollow area. Filler is done in the office and most patients go right back to normal after the injection. Some mild swelling and bruising can occur.

Lower eyelid blepharoplasty is a great option for patients who are in their 30s and up. Surgical blepharoplasty corrects contour issues, tightens the skin and deeper structures to give a natural youthful eyelid.
I perform my browlifts with an endoscopic approach. This is done through 4 small incisions behind the hairline. I use an operating telescope to lift the brow through these small incisions. Recovery is quick. The results are natural, and in the right patients, an endoscopic browlift is an important part of rejuvenating the upper eyelids.
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