Pide cita
Do you want to improve the appearance of your face?
Today, there is a wide range of aesthetic medical treatments that allow us to design a personalized plan to analyze the eyes and enhance the features that convey positivity and a pleasant impression. Sunken under-eyes or aged eyelids can diminish the impact of our gaze or even give an impression of tiredness or sadness, which may not reflect how we feel or what we want to convey.
The eyes communicate even before our words. The power of the gaze conveys a lot about ourselves, showing moods and feelings such as joy and sadness. The main element of a beautiful gaze is the eyes, but we must consider that the eyes are accompanied by a series of surrounding structures that can enhance—or diminish—what we want to communicate.
The presence of hollow under-eyes often conveys tiredness or even sadness. It is a feature that is difficult to conceal, even with makeup. In some cases, the hollowing of the under-eye area is accompanied by darker coloration, sometimes only in the under-eye area, and in other cases on both eyelids.
Hollow under-eyes usually appear due to a loss of volume in the area. The under-eye is precisely the boundary between the lower eyelid and the cheekbone. This loss of volume occurs over time and is compounded by the aging of the lower eyelid skin, which becomes thinner, flaccid, and develops fine wrinkles. In these cases, it is also important to consider the presence of lower eyelid bags, which can increase the appearance of hollowness.
However, hollow under-eyes are not only an aging issue, as they can also be genetic, appearing even at a young age. This type of under-eye can also be accompanied by darkening.
The treatment for hollow under-eyes is done with hyaluronic acid. The filler is applied directly to the sunken area. Initially, it is important to assess whether additional support is needed in the lower under-eye area, near the cheekbone (malar area). Under-eye filler is not a conventional filler, as several factors must be taken into account.
It should be noted that under-eye filling is an advanced filler technique and must be performed by an experienced professional. It is preferable to use a fine, flexible cannula, which allows the hyaluronic acid to be deposited precisely in the correct plane. In certain cases, the treatment can also be performed with a fine needle.
Hyaluronic acid also cannot be just any type; we must use a special filler for under-eyes, such as Teosyal Redensity II® or Volbella®.
Another important point is the amount of product. In the first session, we do not recommend using more than 1 cc of hyaluronic acid in the hollow under-eye area, as a precaution. However, more product can be used if we need to enhance the under-eye support area, that is, the malar area. In this case, the option of restructuring the midface is considered before starting the treatment, which, in addition to providing support to the under-eye, brings youthfulness to the face.
In these cases, the most recommended option is eyelid surgery (blepharoplasty). The preferred technique is the excision of fat pads with transposition of part of the fat, meaning that the fat pads are removed but part of the same pad is used to “fill” the hollow area of the under-eye groove (Loeb technique).
If you are not considering or do not want surgery, there is also the option of hyaluronic acid. In these cases, the injection technique must take the presence of bags into account, so as not to exacerbate them. This allows for a reduction of the tired appearance while disguising the presence of bags.
The difference between hollow under-eyes and bags requires different treatments to ensure that the face does not appear aged or unhealthy.
The appearance of a dark tone in the under-eye area is usually caused by circulatory issues. In most cases, it is genetic in origin, and in others, it can be due to the aging process of the area.
The best treatment options for dark under-eyes are peels and carboxytherapy.
Not just any peel is suitable in these cases, because, as mentioned, the cause of dark under-eyes is vascular, not melanic (like sun spots). Therefore, the recommended peels are mandelic acid, tranexamic acid, or pyruvic acid. Low concentrations are advised since the eyelid skin is very thin. In some cases, the use of retinoids can also be helpful.
Carboxytherapy is one of our preferred techniques, especially for younger patients, as it significantly improves circulation in the area after several sessions. The treatment is very quick and performed with a single small injection on each side. Sessions are initially conducted once a week, and as the area improves, the time between sessions is gradually increased. We recommend starting with a protocol of 6 to 8 sessions and then evaluating based on the results.
Another possible treatment is nanofat, an emulsion of adipose tissue that has been shown to reduce skin pigmentation, possibly due to stem cells from the fat tissue. It is different from conventional fat grafting, which can lead to lipomas or cysts in this area.
The skin of the eyelids is the thinnest on the face and is the first to show signs of aging, even before the age of 30. This skin is very delicate, but at the same time, we must provide the necessary treatments to maintain its appearance.
As you know, excess skin on the upper eyelid is treated with surgery (blepharoplasty), which allows not only the removal of excess eyelid skin but also some fat pads if needed.
For the lower eyelid, excision of skin is increasingly avoided, and techniques such as laser treatment are preferred.
At AGB, we offer two laser options for eyelid skin treatment. Both techniques can be applied to the upper and lower eyelids.
ClearLift™ (Elektra™) Laser: This is a non-ablative fractional ND-Yag laser, ideal for laxity in both eyelids. It works in the dermis while preserving the epidermis (outer layer of the skin) and allows collagen regeneration. Usually, four sessions are required. The treatment is painless, requires no anesthesia, causes no downtime, and is safe for all skin types (I–VI). It can be performed at any time of the year. The advantage of this laser is that it does not cause redness or swelling of the eyelids, so normal routines can be maintained.
Fractional CO2 Laser : In cases of more damaged eyelid skin or deeper wrinkles, we recommend fractional CO2 laser, an ablative laser that improves skin tone and texture and removes fine lines with very fast recovery. It is highly effective and can be combined with transconjunctival blepharoplasty. In these cases, eyelid swelling lasts about 24 hours, and redness resolves in just 3 days thanks to the fractional method. More than one session may be required.
Unlike wrinkles on the lower eyelid, we have the wrinkles known as crow’s feet, which appear when we smile. First, we should never stop smiling, and second, there is a treatment for these expression lines in this area: Botox. It involves the application of small injections in the crow’s feet area, which blocks the formation of wrinkles when we smile. Additionally, the application of botulinum toxin in this area allows for a subtle lift of the eyebrow tail and reduces the appearance of drooping in the upper eyelid.
La Dra. Laura Salvador Miranda es socia fundadora de Antiaging Group Barcelona, con más de 25 años de experiencia en Medicina y Cirugía Estética. Licenciada en Medicina y Cirugía por la Universidad de Barcelona, se especializó en Cirugía General en el Hospital Clínic de Barcelona. Desde 1999 se dedica exclusivamente a la Medicina Estética, liderando desde 2004 el grupo de Medicina Estética y dirigiendo el área de tratamientos láser avanzados desde 2006.
Actualmente es profesora del Máster de Medicina Estética y Bienestar del IFMiL (Universitat de Barcelona – COMB), participa activamente en investigaciones y publicaciones científicas, y es miembro de sociedades médicas como SEME, SELMQ, SETGRA y la Sección Colegial de Médicos de Estética del COMB.
As a medical expert in aesthetic medicine, I recommend that patients with under-eye circles consider options such as hyaluronic acid or calcium hydroxyapatite to fill the area and improve the appearance of dark circles.
In addition, it is important to address the underlying causes of dark circles, such as lack of sleep, dehydration, and allergies, to prevent them from worsening or reappearing after treatment.
The duration of under-eye filler depends on the type of product used and the individual patient’s response. In general, hyaluronic acid lasts 6 to 12 months, while calcium hydroxyapatite can last up to 18 months. It is important to note that the effect of the filler can vary, and retreatment may be necessary after some time to maintain the desired results.
There are several treatments for dark under-eye circles, but the best treatment will depend on the underlying cause of the circles.
Hyaluronic Acid: If the dark circles are caused by volume loss in the eye area, hyaluronic acid can be an excellent option. It is injected beneath the skin to fill the area and smooth the appearance of under-eye circles.
Laser Treatment: If the dark circles are caused by excess pigmentation, laser treatment can help remove the dark pigmentation and improve the appearance of the under-eye area.
Chemical Peels: If the dark circles are caused by an accumulation of dead skin cells, a chemical peel can help exfoliate the skin and improve their appearance.
Topical Treatments: Creams and serums containing active ingredients such as vitamin C, retinol, and kojic acid can help reduce the appearance of under-eye circles.
