Dark Circles and Eye Bags: Filling Volume, Tightening Skin, or Both?

Written by Dr. Evelyn Sterling

Dr. Sterling is known for her compassionate demeanor and personalized approach, taking the time to understand each patient's unique concerns and expectations. Her dedication to patient satisfaction and safety has earned her the trust and loyalty of countless individuals seeking cosmetic enhancement.

Dark Circles and Eye Bags: Filling Volume, Tightening Skin, or Both? An important aspect in the aesthetics of the eye region is the “tear trough.” This refers to the indentation that forms at the transition between the lower eyelid and the cheek. This indentation becomes more pronounced with age as the soft tissues of the face lose volume and gravity causes them to sag. This leads to a pronounced arc under the lower eyelid, dark circles under the eyes, and a tired and aged expression.

The term “eye bags” is more commonly used, which describes both the bulging of fat behind the orbicularis oculi muscle of the lower eyelid above the trough, and the excess skin that hangs like a garland over the cheek (known in English as “festoons”). Eye bags and tear troughs are like the mountain and valley of an appearance that disturbs the youthful, soft transition between the lower eyelid and the cheek.

Any endeavor to rejuvenate the eye region should include this zone. The two components that can be improved are volume loss and thin, translucent skin, which allows the underlying blood vessels to show through and causes the dark color.

Options for correcting dark circles include:

1. Building volume at the tear trough by injecting one’s own fat or fillers (e.g., hyaluronic acid). This can model a soft transition between the lower eyelid and the cheek, but it does not correct a pronounced excess of skin. The procedure is not simple, as the region is anatomically complex, and over-treatment can make the eyes appear smaller.
2. Improving skin structure and thickness with minimally invasive measures such as laser skin resurfacing, microneedling, radio frequency and ultrasound treatments, and PRP injections. The improved blood flow and collagen production during the healing process make the dark shadows less visible. However, this hardly improves a deep tear trough.
3. Repositioning the fat behind the lower eyelid over the bony edge of the eye socket as part of a lower eyelid lift. This also involves removing excess skin. The skin incision is either at the edge of the lower eyelid, directly at the lash line, or even at the mucosal fold inside.
4. Direct removal of excess skin in cases of pronounced excess at the transition between the lower eyelid and the cheek.
5. Often, a combination of several procedures represents the best solution for correcting noticeable dark circles.

To determine which measures have the best prospect of success in your case, or whether minimally invasive measures suffice or a surgical option is better suited for you, it is best to consult with a certified plastic surgeon.