How do I get rid of those dark circles under the eyes? Eyelid surgery vs fillers


If we look at the internet, the most common search term when it comes to ageing is ‘wrinkles’ – quickly followed by ‘dark circles under the eyes’.

Heavy bags under the eyes not only make us look older, they can make us look tired, too.

So, what are the causes and what are the cures of this problem that many of us feel adds years to our appearance?

The skin directly under the eyelid is attached to the bone so it cannot move. The skin above that is loose – it’s your lower eyelid – and there’s nothing behind it except fat, muscles and tissue.

As we age, the fat herniates and pushes the skin out to create an ‘eye bag’, whilst the skin attached to the bone doesn’t move so as the lower eyelid protrudes out, it creates a shadow on the depressed skin that remains attached to the bone.

The skin around the eyes is ten times thinner than the skin on the face and we also lose elasticity over time as our dermal collagen weakens.

This can be further aggravated by sun exposure, smoking and other environmental exposures – giving us a sad and ageing appearance.

Lower eyelid surgery improves the tired and aged appearance that you feel you may have. It provides freshness to the eyes and gives the whole face a brighter look.

Tear trough treatment (or lower eyelid rejuvenation with filler) can help rejuvenate an aged appearance.

Here, consultant plastic surgeon Marc Pacifico, an expert with, takes a look at a safe and effective routes to treatment.

When is surgery appropriate?

Fillers have revolutionised approaches to lower eyelid rejuvenation. However, surgery still maintains the fundamental core approach in most situations. Surgery is most appropriate to deal with skin laxity or crepey skin. Surgery can also deal with bulging fat pads, either by reducing them, or by moving the fat to fill lower eyelid grooves (tear troughs). Finally, a mid-face lift can be performed through a lower eyelid incision, to lift and rejuvenate the triangle of the face that sits between the lower eyelid and the nasolabial fold (nose to mouth lines).

What can I expect re: outcomes/downtime?

There are many surgical approaches, and the downtime really depends on the extent of the surgery. Usually, for most operations, the stitches are removed by a week, and there is still swelling and bruising to resolve after that. Most people would take 8-10 days off work, but the final result cannot be judged until around 4-months after surgery

Is it a safe procedure?

Lower lid surgery tends to be safe. However, like all surgical procedures there are risks. The specific risks tend to relate to the position of the lower eyelid after surgery, in that lid-malposition can be problematic in some people, both due to its appearance and the functional problems (such as watery eyes) it can create. The risk of blindness is incredibly rare, but has been reported.

How best to choose an appropriate surgeon?

Not all surgeons perform lower eyelid lifts, so it is key to find a plastic surgeon who performs lower lid surgery regularly. It goes without saying that ‘before and after’ photos of the surgeon’s work should be seen and, ideally, they should be a member of the British Association of Aesthetic Surgeons (BAAPS).

Does surgery last forever?

No surgery lasts forever. We continue to age and our tissues continue to change with age. Eyelid surgery tends to last a long time, and we do not do many lower lid secondary operations, certainly not to the extent that we do with facelifts (which may be done after around 10-years)

Are fillers a decent temporary solution?

Fillers have a key role in improving the groove below the eyelids, the tear trough. They are especially useful in people with early facial ageing, and also in those without significant skin excess. In my practice, I am increasingly using fillers, and also using them to enable me to perform less invasive surgery, as combined approaches.

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