Will Infraorbital Implants Help With My Dark Circles?

Q: Dr. Eppley,  I am reaching out because I have been researching options to address significant under-eye hollowness and dark circles, and I was very encouraged to find your work with infraorbital (lower orbital rim) implants. Seeing the results you have achieved for other patients has given me hope that there may finally be a solution for my concerns.

Over the years, I have pursued several non-surgical treatments without achieving the improvement I was hoping for. I initially had under-eye fillers placed, which were later dissolved. After that, I underwent mid-face filler treatment in an attempt to provide additional support to the under-eye area. More recently, I tried PRF with EasyGel. In addition, I have undergone microneedling treatments.

Unfortunately, despite these efforts, I continue to have significant under-eye hollowness. None of the treatments have meaningfully improved the volume deficiency, and they have also had little to no effect on the dark appearance beneath my eyes. I have been told that much of the discoloration may be related to the underlying anatomy and the visibility of the muscle beneath thin skin, which limits the effectiveness of many non-surgical options.

Because of this, I became very interested in the possibility of infraorbital rim implants. Based on the information available on your website and the patient results I have seen, I would love to learn whether I might be a candidate for this procedure and what kind of improvement could realistically be expected in my case.

A:Thank you for your inquiry and sending your pictures. You have the classic problem but I see all the time with the combination of undereye hollowing and dark circles of the lower eyelid and cheek– groove skin.. Which is not uncommon in your ethnicity and intermediate skin pigment. The key question is what is the association of your undereye hollowing and the dark circles or, to put it another way, if you structurally correct your undereye hollowing will you get any reduction in the appearance of the dark circles?

The answer to that question is whether the dark circles are due to shadowing from the lack of structural support or is that actually hyperpigmentation of the skin which may not get any significant improvement with increased structural support. My concern in your case that it is more likely the latter rather than the former. Generally dark circles that have a major contribution for lack of structural support have an actual shelf where the shadowing can occur. You however do not have that as your lid profile is very straight and flat which would indicate to me this is largely hyperpigmentation not shadowiing effect.

That being said I decided to test out what would happen if structural support was added which I have done in the attached Image. In that image all I did was add structural support and did not change any color of the skin. Surprisingly I do see improvement in your undereye condition. Whether actual surgery can the same effect as a simple Photoshop change is an interesting question but this is the best method we have to try and approximate what a surgical change may create.

Dr. Barry Eppley

Plastic Surgeon