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Under Eye Hollows and Dark Circles Treatment


By: Dr. Leonard Einstein DNP, APRN

Double Board Certified Nurse Practitioner



Hollowness and darkness under the eyes can be a separate or concurrent problem with puffy under eye bags. Although it seems contradictory that someone can suffer from both excess volume and a lack of volume under the eyes, in reality having them both can make each problem look worse – it’s like the valley next to a mountain next to it appears taller.




What Causes Under Eye Hollows?

Hollow under eyes, commonly referred to as tear troughs because of their depth and position in the face, is a problem suffered from a lack of volume in the under eye area. Like puffy under eye bags, it can leave people looking tired, older, and lacking energy.

While eye bags sufferers have an excess of fat under the eyes, hollowness is a lack of fat under the eyes, with thinness of lower eyelid skin also a contributing factor. Under eye hollows can be a genetic issue, and also aging related issue of the diminishment of fat and soft tissue as one gets older.




UNDER EYE HOLLOWS IS TREATED WITH A COMBINATION OF A HYALURONIC ACID FILLER LIKE RESTYLANE FOR THE VOLUME DEFICIT, AND PLATELET-RICH PLASMA TO EXTEND THE LIFE OF THE FILLER AND IMPROVE QUALITY OF UNDER EYE SKIN.



How to Fix Under Eye Hollows

There are several treatment options for under eye hollows, and physicians and nurse practitioners have their preferred choices of treatment.



Dermal Fillers for Hollow Under Eyes

The most common treatment for under eye hollowness is the use of a cosmetic hyaluronic acid filler such as Restylane L or Juvederm  Volbella which is FDA approved for this particular area to restore volume under the eyes. Hyaluronic acid occurs naturally in the body, so these fillers are generally hypoallergenic.

Since cosmetic fillers are injectables, this treatment can be done by non-surgical physicians such as dermatologists and nurse practitioners . However, it is important to keep in mind that filler application is not a generic procedure, but an art.

Using the right amount of filler, and in the proper place, is where an injector’s skill, aesthetic style, and value comes in. It is important to seek the skill of the practitioner  with fillers, not just base the decision on price alone. Since fillers break the skin through injection, and introduce a material into the body, Board Certified Nurse Practitioner Dr. Leonard Einstein  approaches filler treatment as invasive procedure, and treats it like surgery, although technically it is a non-surgical procedure.

Using hyaluronic acid fillers for the lower eyelids is a much safer option than fat grafting. While fat seems to be a good choice since it is natural and part of your body, fat grafting, or fat transferring, under the eyes is highly risky procedure. Fat is unpredictable and inconsistent in texture, and may be lumpy once placed in the lower eyelids.

Thin eyelid skin may reveal the various inconsistencies and irregularities of fat under the eyes. Fat does need a blood supply, and may not take to the available blood supply of the lower eyelids. Fat is also absorbed by the body. Fat transferring/grafting is a surgical procedure, unlike injectable fillers.

Removing grafted fat from the lower eye area is also a complicated and costly procedure and requires a plastic surgeon instead.


Unlike tear trough implants, hyaluronic acid fillers are temporary, with the material safely absorbed by the body with time. Hyaluronic acid fillers do require periodic maintenance, from every few months to perhaps a year, depending on how fast an individual breaks it down the material.

The temporary nature of fillers can also be an advantage, as overfilling or placing the filler in the wrong place can happen with practitioners who lack experience with them, or have different aesthetic style than their patients. In such cases, hyaluronic acid fillers can be dissolved using the enzyme Hyaluronidase.



Platelet-rich plasma (PRP) and hyaluronic acid filler

Nurse Practitioner Dr. Leonard innovated the combination of hyaluronic acid filler with platelet-rich plasma (PRP). This unique combination actually extends the effective life of the hyaluronic acid filler, so need for periodic maintenance is also reduced.



Platelet-rich plasma is a material derived from the patient’s own blood. Blood is drawn like a normal blood test, then is spun in a centrifuge to concentrate and separate the plasma from the red component of the blood. Plasma is a clear, yellow serum that makes up a major part of the blood. Platelet-rich plasma is a concentration of the growth and healing factors contained in blood plasma.



Using PRP also helps treat the skin and increases blood supply to the under eye area. PRP contains several growth and healing factors that are usually used by the body to heal cuts. Placing these growth and healing factors under the eyes improves the health of thin eyelid skin, increases blood supply to the area, and triggers a collagen production response in the area. This gives the PRP treatment area a unique glow, something not experienced with any other injectable treatment.




Causes of Dark Circles Under Eyes

Puffy eye bags and hollowness under the eyes commonly have dark circles under the eyes. There are several issues that could cause dark circles:

  • Pigmentation caused by genetics or sun exposure

  • Pooling of blood, or collection of iron deposits from the blood in the lower eyelids

  • Thin eyelid skin caused by genetics or aging to the point of translucent skin, showing anatomic elements like veins and blood vessels

  • Allergies that cause swelling of blood vessels under the eyes (allergic shiners)

  • Dietary issues like too much salt causing blood vessels to take on a bluish tinge

  • Lifestyle choices like smoking, which can make blood vessels under the eyes appear darker



Morpheus8 for Under-Eyes Benefits


1. Reduces the signs of aging without surgery

One of the primary benefits is that it can reduce the appearance of dark circles and bags under the eyes. These are common concerns that many people struggle with as they age, and Morpheus8 can help to minimize their appearance without the need for surgery or other invasive procedures.


2. Reduces crepey under-eye skin

Another benefit of using Morpheus8 under the eyes is that it can help improve the overall texture of the skin. As we age, the skin around the eyes can become thin and crepey, making it look tired and aged. Morpheus8 can help to tighten and firm the skin, reduce the appearance of lines and wrinkles, and refine and enhance the texture of the skin.


3. Visibly tightens under-eye skin

Morpheus8 is also effective at addressing other concerns, such as crow’s feet and sagging skin around the eyes. By stimulating collagen production, the treatment can help to tighten and firm the skin, resulting in a more youthful and refreshed appearance.




Morpheus8 Provides Skin Rejuvenation With Virtually No Downtime

Using Morpheus8 for under the eyes can provide many benefits that were historically only obtainable through surgery.

One of the best things about Morpheus8 is that it is a non-invasive treatment that requires minimal downtime. Patients can typically resume their normal activities immediately after the procedure, making it a convenient option for those with busy schedules.



If you would like to improve the appearance of your under eye , give us a call and schedule your consultation with us at (305) 518-1112. Our office is in the city of Aventura conveniently located to serve Miami and Fort Lauderdale area.

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