Treatment of Under-Eye Dark Circles and Bags: Tear Trough Fillers, Lasers, and Blepharoplasty
Arising from dermal pigmentation, tear-trough hollows, or herniated orbital fat, under-eye pathology is managed via tear-trough fillers, lasers, or lower blepharoplasty.
Key points
- Etiological Differential: Shadowing from tear-trough hollows responds to hyaluronic acid fillers; true orbital fat herniation demands surgical lower blepharoplasty.
- Tear Trough Fillers: Formulated with non-hygroscopic hyaluronic acid and amino acid complexes, placed supraperiosteally via blunt cannulas to erase under-eye hollows.
- Pigment-Targeted Lasers: Melanin-induced dyschromia is resolved via Q-switched or fractional lasers that fragment epidermal pigment deposits.
Tear Trough Filler Protocols and Preventing the Tyndall Effect
Periorbital skin is the thinnest integument on the human body (~0.5 mm). Superficially placed or overly hydrophilic hyaluronic acids cause Rayleigh scattering of light, manifesting as a bluish-gray discoloration termed the Tyndall effect, coupled with chronic edema. Expert injectors use low-hygroscopic, resilient formulations deposited strictly onto the periosteum of the infraorbital rim utilizing 25G or 27G blunt micro-cannulas, ensuring smooth light reflection without edema.
Lower Blepharoplasty Surgery: Indications and Techniques
When under-eye volume presents as true orbital fat pseudoprolapse (bags) caused by orbital septum laxity rather than a volumetric trough, fillers exacerbate bulging. Surgical lower blepharoplasty is indicated. In younger patients with good skin elasticity, the transconjunctival approach enters through the inner eyelid lining, excising or transposing fat pads without cutaneous incisions. When excess skin laxity coexists, a subciliary approach trims redundant skin.
References
- Haddock NT, et al. Lower eyelid blepharoplasty: dynamic anatomy and volume restoration. Plast Reconstr Surg. 2009;123(4):1337-1344.
- Sharad J. Dermal fillers for the treatment of tear trough deformity: a review. J Cutan Aesthet Surg. 2012;5(4):229-238.
- Rohrich RJ, et al. The anatomy of the tear trough: a fresh look. Plast Reconstr Surg. 2003;112(3):873-885.