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Surgical and Non-Surgical Treatments For Dark Circles


Video Transcript


Sarah: Hi guys, welcome back to the channel! I’ve got something rather special for you coming up over the next few weeks. I’m going to be sat here with a couple of oculoplastic surgeons. We’ve got Rachna and Jonathan here from Face Restoration and we’re going to be talking about a wide variety of different things all to do with the eyes. I don’t know how many we’re filming because we’re just riffing it as we go along but hopefully, you will enjoy the series.


Sarah: Let’s take it away first of all by talking about dark circles underneath the eye and how you would fix them as surgeons. What’s the cause?

Rachna: There are lots of things that can cause it. This is the area where our skin is really really thin so it’s the thinnest skin in the whole body, less than half a millimeter in terms of thickness.  The skin covers lots of little blood vessels and those blood vessels you can see quite easily underneath the skin. Particularly when you have fair skin, you can see blood vessels underneath and so that can give the impression of darkness.

Jonathan: If you have a weakening of something called the septum which attaches the lid to this bone, you can get fat pulling forward and we tend to see this as you get older. And that can then, in a certain light, you can create a shadow and so sometimes the dark circle isn’t just these blood vessels it’s actually the way the light shines on the face. Then if you can alter the contours either by reducing the bags or filling in the trough, you can again change the appearance. So when you’re younger, we have these nice puffy little cheeks and they sit up quite high. As we age when we get dehydrated, things move down, and that then stretches that skin.

Sarah: Sounds grim. What about in a patient who’s 20 and they’ve got dark circles?

Jonathan: The sorts of things we can do then is try to plump things up. We can try to lift these tissues up a  little bit either surgically or non-surgically, we can try to make the skin a little bit more full or hydrated again with the fillers that you use.

Rachna: But a lot of people do have pigmentation in their skin as well, so that’s a very common cause for dark circles.


Sarah: Okay, so you just mentioned that you’re using filler around the eye do you guys have a preference?

Rachna: The Juvederm range of products.  So I would use something like Volite in the skin.

Jonathan: When you’re lifting the heavy tissues you want a molecule or a product that’s going to be long-lasting and has lifting power. So for that, we would use something like Voluma for example.

Sarah: I use a lot of Teosyal Redensity 2 under the eye. Keith uses a lot of Restylane Vital Light.

Rachna: We use a combination of Voluma Volift and Volite to treat the eye bag area. But if you’re going to use something that lifts in the eye area where you’ve got very thin skin, it can give you a very nasty look where you can sometimes see it in some people who have had these treatments the appearances of these blue pools of filler sitting in the eye bag area. And that’s called the Tyndall effect. So when we look at the sky, the sky looks blue because the light is split and we see the blue light come through. And the same thing happens when you put a big blob of filler, the wrong filler in the teardrop area and it looks very blue.

Jonathan: This area is covered with blood vessels and they’re slightly unusual blood vessels because they connect to each other. You can go from one artery into another with a product and that can be very dangerous.


Sarah: Okay, so how would you do it surgically?

Jonathan: You can fill with fat, you can reposition fat from the area around the eyeball or you can lift fat from the face and I think that summarizes the different surgical approaches. What some of us like to do is to actually take fat from another part of the body, sometimes from under here or from a thigh or an abdomen, spin it down, get the fat, and then re-inject it into different places. And that can have a nice looking effect and it can plump up and it can be long-lasting but there are a few downsides. One is that it’s got a higher risk of embolism and you can’t dissolve it. If you’ve got fat flying around the circulation there’s not much you can do about that.
The other thing is sometimes these fat transfers can end up looking a bit lumpy rather than getting a nice smooth area. And sometimes afterwards they can grow because these are living cells that you’re repositioning. So if you gain weight somewhere you might gain weight there.

Rachna: You don’t want to gain a lot of weight.

Jonathan: Sometimes these cells die, so you put in a certain amount and then you end up getting less of an effect than you thought. And sometimes these cells do very well and they grow and you end up having more of an effect. What’s nice about the hyaluronic acid filler is that it’s very precise. Fat transfer is good because it lasts forever potentially and it can have a very nice effect on the skin as well but it is more dangerous and it’s less predictable.

Rachna: The fat is now spun down and it’s now more nano fat so the chances of having the little lumps and bumps it’s much less.

Jonathan: You can also reposition fat and what some of us like to do is we like to take fat from just around the eyeball. There’s a little piece of cellophane here we can go in and pull fat out from around the eye and fill in the trough. But the risk of that is that when you do that you could end up with more of a hollow at the top and you can end up having the eyeball look like it’s no longer cushioned in that nice sort of soft fluffy surrounding which makes us look young, youthful. And you can end up looking more skeletized and older.


Sarah: I know what they’re going to be thinking at home right now: “Give me something that I can do at home.” So do you have any suggestions?

Rachna: Vitamin C, serums are good for pigmentation in the under-eye area as well as on the skin generally. Then Hydroquinone and then Cyspera. Certainly, you can put hyaluronic acid and plump up the skin as well as a topical.

Sarah: If you’ve got pigmentation underneath the eye you can use something like Cyspera, Hydroquinone which is prescription only. If it’s more of a skin quality issue then you’re looking at using what, vitamin A, hyaluronic acids, peptide acids.

Rachna: Which are also prescription and the peptides you can have it topically. You can also take collagen, you know, by mouth as well as drinks or there are various different brands and products.  And so I like the ZENii range and also Skinade as well, you know there’s plenty around which will help to hydrate as well.

Sarah: Top tip from me guys. Cernor XO vitamin K cream for dark circles also works well.
So in terms of things that I also use around the eye non-surgically, would be things like Carboxytherapy but you need a lot of treatments for that to work. Tends to work better in people with darker skin tones. LightEyes which is mesotherapy, is from a company called Promoitalia and works really really well. Sometimes a bit of SuneKOS as well if the skin texture is quite creepy, that’s the SuneKOS 200.

Face Restoration Questions and Answers


Face Restoration Questions and Answers

Dr Jonathan Roos and Dr Rachna Murthy specialise in diseases of the eyes, eyelids and facial aesthetics. They answer your most asked questions.


We do everything that focuses on the eye area and non-surgical treatments for the whole face that include toxins, fillers and skincare.

Different things have different risks. The toxin treatments we do for wrinkles and for lifting the face, wear off after three to four months so the risks are minimal. With the fillers, we’re extremely experienced with it,  in fact, Rachna sits on the International Advisory board for complications and so knows how to deal with just about anything.

So we’ve invested a lot of money into something called the Optilite IPL and it allows us to treat rosacea dry eye blepharitis. A lot of people suffer from watery eyes and dry eyes. We have an effective treatment for it which can make you drop free.

With every consultation, we offer a complimentary skin analysis and then we’re able to prescribe medical-grade skincare that’s directed towards your individual skin.

So we’ve been doing this for many years now and we learn from every patient we have gotten downtime down to the absolute minimum. We hardly bruise our patients so they have minimal swelling and we have lots of secret tricks to achieve that.

I mean blue light resets your circadian rhythm and can make falling asleep difficult.

We all have a colony of bacteria and viruses that live within our gut on our skin on our eyelids and if the microbiome is upset by antibiotics or the environment or anything that we do pollution then it can cause inflammation and we don’t like inflammation because that causes aging and we have the perfect treatments for microbiome resetting.

You know we all have dark under-eye circles. even babies have dark under-eye circles and there are multiple things that it can be caused by. It can be caused by the skin, the pigmentation, and the Contour changes so when we age everything starts to Sag and then we see this rim of the eye socket much more. It can be due to very thin skin in this area so you can see the blood vessels underneath and we have different approaches for the individual.

We start from the beginning we start with skincare and as people get older if there’s hooding and wrinkles then we may think about surgery, but it’s a it’s a discussion it’s a discussion that we have with you and decide what’s appropriate.

Absolutely not! We’ve perfected recovery to keep it less than a week to just a few days.

Well, nothing ever that is surgical will not hurt at all but we have lots of little tricks up our Sleeve to make it as painless as possible.

Surgery can cause bruising, but we’ve worked very hard and meticulously to minimize the bruising. I think we probably get the least bruising possible with our surgery.

We don’t create duck lips we make you look fresh and classy the way you did when you were younger. It’s not about changing you it’s about restoring you and that’s why we called our Clinic face restoration because it’s about getting you back to your best self.

No, you’re not going to look done you’re going to look like a better version of yourself.

We do all of our surgery under local anaesthetic.

No, you don’t have to stay overnight. If it’s surgery the operation takes anything between an hour for both upper eyelids to an hour and a half for all four eyelids. If it’s not surgical, it’s a non-surgical injectable tree movement, then it’s in the office and it’s done in 15 minutes.