The under-eye area is one of the most requested treatment zones in aesthetic medicine, and also one of the most misunderstood. Frustration naturally ensues with the abundance of conflicting advice and store shelves stocked with products promising solutions. Effective treatment starts with identifying the underlying cause. Not all under-eye concerns are the same, and thus no two treatment plans are alike.
The skin around the eyes is the thinnest on the face and overlies a complex network of structures: fat pads, muscle, and bone. The under-eye area is a sensitive cosmetic subunit, meaning it requires a level of precision that not every treatment nor provider can offer. Getting it right makes a significant difference. Getting it wrong can be highly visible.
If dark circles, dullness, or thin, crepe-paper texture under the eye is a concern, I recommend the following:
PRFM (Platelet-Rich Fibrin Matrix) for skin rejuvenation is one of my favorite treatments. PRFM uses your own blood, processed to concentrate growth factors, and is placed directly in the under-eye skin. PRFM injections stimulate collagen and improve skin quality over time. It's autologous, well-tolerated, and has low recovery time. This technique is particularly effective for discoloration caused by skin thinning.
Microneedling and lasers can also meaningfully improve skin texture and discoloration in the under-eye area, but being in expert hands is non-negotiable. The wrong settings or an inexperienced operator can cause significant detriment. Done correctly, these treatments improve skin quality and under-eye discoloration.
Eye creams can also be beneficial. A medical-grade product used consistently can support skin quality and hydration. I recommend the SkinBetter Science Eye Cream, which contains a blend of antioxidants that address texture, tone, and firmness without causing irritation.
One thing that often gets overlooked: allergies. Chronic allergies can worsen under-eye discoloration. If you haven't properly addressed underlying allergies, this may be inhibiting your treatments. If this is relevant to you, it's worth a conversation with your primary care provider or allergist.
For true volume loss or hollowing of the under-eye:
Injectable hyaluronic acid filler placed along the tear trough can be effective. When done with the right product and technique, it softens the shadow and restores a more rested, refreshed appearance. This is one of the higher-risk areas for filler and should only be performed by an experienced injector who understands the anatomy and filler rheology.
It's also worth knowing that not every under-eye concern can or should be treated with filler. Herniated fat pads, also called under-eye bags, are caused by fat sliding forward from its usual position. Surgery such as a lower blepharoplasty is the appropriate solution in these cases. I will always be transparent about that rather than recommend a treatment that won't address the root cause.
Under-eye treatment works best when it starts with a thorough assessment. The options available, including PRFM, skin treatments, eye cream, allergy management, filler, or surgery, each serve a different purpose. The goal is matching the right solution to your specific concern, not applying a one-size-fits-all approach to one of the most delicate areas on the face. A thorough consultation is of utmost importance.