Thank you for your question.
You submitted several photos and you describe in your history that you exercise once or
twice a week, that you sleep 6-8 hours a day and you're generally in good health and
you are someone who feels generally well.
And you're wondering why you have the appearance under your eyes of dark circles.
Well, I can certainly share with you my approach to answering this type of question which occurs
in our practice every day.
A little bit of background, I'm a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And helping people with the under eye area whether it's dark circles, hollows and puffy
under eye bags, it is a significant percentage, a high percentage of what we do in our practice
every day.
So to begin with, certainly without a proper examination, a physical exam, and seeing you
at different angles and looking at the quality of the skin, etc., I would say that what you
are most likely dealing with is first, genetics.
Certain ethnic types tend to have this issue with dark under eye circles.
In my general perception, it is basically people with Mediterranean to darker skin types.
So that includes anybody from Italian, Greeks, people from the Middle East, Indians.
It is an extremely common issue.
When we look at the under eye area, basically, we're looking at how much of the dark circle
is contributed by pigmentation, the actual color of the skin, how much of it is contributed
by relative hollow.
In other words, the position of the skin as it relates to the area of the bone called
the tear trough and infraorbital rim.
And then of course, there are other issues whether it's allergies or vascular issues
where you can actually look through the skin and you have something called allergic shiners.
Now that being said, it is common practice for us to discuss certainly the options.
But very importantly is that you have to decide how much does this bother you and are you
willing to now do something that's going to require maintenance.
A famous dermatologist said that in dermatology, you never cure anybody but you make everyone
better and you try everything to make people better.
It's actually about management and not about cure.
So in a situation like under eye dark circles and hollowing, together, it is routine for
us to address the hollowing with an under eye filler and usually, it's in the hyaluronic
acid family.
And basically, it's a filler that is similar to the natural hyaluronic acid that exists
in your body.
So it's very well tolerated, does not require any type of allergy testing.
And in addition, with the skin quality, we have a lot of success in helping people with
something called platelet-rich plasma (PRP).
Platelet-rich plasma is derived from your own blood and it is a concentration of the
wound healing factors required for when you have an injury like a cut.
What happens is you get an increase in collagen, blood supply and basically the color and the
melanin production is actually affected and this has been shown in studies with PRP.
And so, it actually has a nice holistic lightening effect in the skin.
It doesn't eliminate the darkness.
We cannot bleach the skin.
But I would say that it can make the eyelid skin look healthier.
So the typical or the general concept of the whole is greater than the sum of the parts,
when you add volume correction with the PRP, basically volume correction with skin quality
improvement, there's a nice result.
Now, the only issue here is of course is that you have to repeat this.
And depending on the age of the patient, it is something that I really prepare them for
especially when people come in who are in their 20s or early 30s and see if they are
ready to really embrace this kind of ongoing maintenance.
A lot of times, it's worthwhile to just try it.
You know, with a procedure like this which is relatively safe and is non-surgical even
if it's still an invasive procedure, you can at least see if you like the results and
if it's justifiable to you in terms of your allocation of time, energy and resources to
actually do this.
So learn more about this.
I would say meet with experienced, cosmetic doctors who do a lot of this type of filler
in the under eye area as well has experience with PRP.
There are lot of people who still remain stubbornly skeptical about the benefits of PRP but slowly
the dermatology literature and other medical literature in the aesthetic field is recognizing
the benefits.
It has already been established well in other specialties and other fields.
So it's important to at least learn about these options and see if it fits for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.
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