top of page

<Insights> 2 Combination Therapies for Dark Circles Treatment

According to the report of American Society of Plastic Surgeons, procedures aimed to improve the appearance of the eyes are some of the most sought after aesthetic rejuvenation treatments. In 2017 alone, over 200,000 women and men underwent eyelid lift surgery, or blepharoplasty, at the hands of board-certified plastic surgeons, there are many more non-surgical eye rejuvenation procedures being performed by doctors of other specialties.

Patients who wish to undergo eyelid rejuvenation often complain of one or more of the following:

  • Looking tired or fatigued

  • Heavy, droopy lids

  • Under-eye bags or puffiness

  • Excess, wrinkled skin

Most of these issues can be successfully corrected with eyelid surgery or non-surgical combination therapies. In this week's newsletter, we are focusing on the topic regarding total eye rejuvenation, particularly in solving the dark circles that many adults are facing.

Recommended Combination Techniques for Total Eye Rejuvenation

Brown or Blue Pigmentation

Topical Eye Creams + IPL Therapy + Skin Booster

Brown pigment: benefits from an adjunctive skincare regime with topical eye creams that contain vitamin C, retinol, kojic acid and resveratrol to brighten and thicken the skin.14 Blue pigment, due to leaking blood products is thought to be improved by eye creams that contain vitamin K (to improve the damaged capillaries).12 When blood vessels are visible as dark purple or blue under-eye circles, intense pulsed light therapy (IPL or Photofacial) may be suggested to reduce these dark circles. There are also many skin boosting treatments to choose from for this indication, such as Belotero Balance dermal filler, however , Dr Sabrina Shah-Desai, an ophthalmologist and oculoplastic surgeon prefer to use Restylane Vital Light to help reduce the shadows from dark brown pigment and by plumping the skin to mask some of the blue discoloration from venous pooling.

Volume Loss:

Combination Filler Technique

In the past articles, we mentioned the benefits of hyaluronic acid fillers that could help rejuvenate the eye condition and warned of the potential danger zones of this procedure. However, Dr Shah-Desai raised the concerns regarding over filling in the hollow which could potentially worsen the deformity. Thus, a combination of techniques for treating dark circles are recommended to reduce the swelling capacity in a layered manner in the hollow.

Place deep filler with a lifting capacity (i.e Restylane Perlane, Emervel Deep, Juverderm Ultra) at the lid cheek junction using a needle and inject small aliquots of the product in a retrograde fashion. The product is placed in the supra-periosteal plane (deep to the orbicularis muscle). The second layer is placed between the orbiculares and periosteum at three points a softer product (i.e Restylane Lidocaine, Volbella, Emervel Classic). The product is gently massaged to smooth the tear trough depression.

In patients with loss of volume in the lower eyelid (i.e due to thin skin or loss of underlying subcutaneous fat), Products similar to Restylane Vital Light is advised to be injected into the thin eyelid.

TIPS: What to take note when accessing patients

Define the extent of the patient's hollow

  • Loss or descent of fat underneath the eye and cheek manifests in a more pronounced under-eye groove (unmasking of the tear trough deformity). Protruding fat creates an illusion of a deeper tear trough deformity due to shadowing, and a globe malposition results in a dark shadow over the lower eyelid. Having a clear vision of the volume loss helps you to come up with a better treatment plan combing cheek and tear trough filler.

Differentiation of discolouration from purple/blue tint in dark circles

  • Pull the eyelid sideways and if the darkness improves, the problem is caused by excess skin pigment in the area.

  • Patients with history of thyroid or renal dysfunction, allergic rhinitis, hay fever or seasonal allergies, associated with puffy eyelids, often have violet/blue pigment due to venous congestion or leaking blood products.


  1. M.Cane, ‘Treatment of tear trough deformity and lower lid bowing with injectable hyaluronic acid’, (Aesthetic Plastic Surgery, 2005), (29), pp.363-367.

  2. Wong CH et al, ‘The tear trough ligament: anatomical basis for the tear trough deformity’, (Plastic Reconstructive Surgery, 2012), (6), pp. 1392-402.Haddock NT, et al, ‘The tear trough and lid/cheek junction: anatomy and implications for surgical correction’, (Reconstr Surg, 2009), (4), pp.1332-42.

  3. Stutman, Ross L., and Mark A. Codner. ‘Tear trough deformity: review of anatomy and treatm options’ (Aesthetic Surgery Journal) 32.4 (2012), pp.426-440.



Learn more about the cutting-edge techniques and get the hands-on experience on real patients for Combination Therapies of Non-surgical Eye-rejuvenation by registering for:

Hands-on Master Class

Advanced Non-Surgical Combination Therapy for Total Eye Rejuvenation:

Eye Bag Removal, Eye Lift & Non-Surgical Blepharoplasty using Botulinum Toxin, Fillers, PRP and Innovative Light Based Devices

July 29, 2018 | Sydney, Australia


More Upcoming Courses

IFAAS's Hands-On Master Class:

Korean Advanced Non-Surgical Face Lifting Using Aesthetic Injectables, Devices & Thread Lifting

June 9-10, 2018: Munich, Germany Program (Last 1 Seats)

June 17-18, 2018: London, United Kingdom Program (Last 2 Seats)

July 14-15, 2018: New Jersey, United States Program

July 28, 2018: Sydney, Australia Program

Aug 4-5, 2018: LA, California, United States Program

Aug 23-25, 2018: Seoul, South Korea Program

Sept 14-16, 2018: Singapore Program

Sept 22-23, 2018: Sydney, Australia Program

Register now

Global Event Calendar

bottom of page