If you search for solutions for dark circles under your eyes, the remedies you’ll find will range from at-home options like brightening creams to getting under-eye filler, like Juvaderm or Restylane, from a dermatologist. First of all, you’re definitely not alone in noticing dark or hollow under-eyes–this common issue can be a result of genetics, the natural aging process, or lifestyle factors—like not getting enough water or sleep. (And let’s be honest, the last couple of years have been exhausting for many of us, and your skin is probably feeling it, too).

Under-eye filler, or any dermal (skin) filler, may seem like a drastic choice, but the truth is that it may be one of the few things that can actually change the appearance of your under-eye area for real, depending on what’s causing your dark circles. However, before you start googling dermatologists, it’s important to know how safe it is to get filler under your eyes, and what you can really expect before, during, and after getting under-eye fillers. That’s why we asked a few top dermatologists what you should know ahead of making an appointment—the expert advice below can help you decide whether or not under-eye fillers (or just a better eye cream) are the right move for you.

What can under-eye fillers treat? | What’s the difference between fillers and Botox? | Is it safe to use fillers under your eyes? | What can you expect from the treatment? | How do you prepare for under-eye filler? | What can you expect after the treatment? | Is it safe to use fillers under your eyes? | What else should you know? | Can you treat sunken eyes without fillers?

What can under-eye fillers—a.k.a. tear trough fillers—actually treat?

The main reason to get under-eye fillers is to fill a hollowness under the eye colloquially called, yep, a “tear trough,” Noelani Gonzalez, MD, board-certified dermatologist and director of cosmetic dermatology at Mount Sinai West, tells SELF. If you have this type of hollowness or loss of volume in that area, you might have dark circles or shadowing under your eyes.

It’s important to distinguish dark circles or puffy eyes caused by loss of volume or your basic anatomy (both of which can be hereditary) from under-eye wrinkles or dark circles caused by hyperpigmentation in the area, Jenny Hu, MD, board-certified dermatologist and clinical associate professor of dermatology at the Keck Medicine of USC, tells SELF. “If a patient has true pigmentation, then the dermal filler won’t help,” she says. In other words, if the skin under your eye is darker because that’s your natural complexion or because of prior sun damage, dermal fillers unfortunately won’t change it (and don’t worry, a dermatologist can help you make that determination). If, however, the darkness is a result of skin laxity from aging or genetics, then a filler may help by adding volume and evenness to fill the hollowness of the dark circles, without adding puffiness.1

Also, under-eye fillers won’t do much for people with larger bags under the eyes, especially if fat has collected in the area, which can happen as you age, Dr. Hu says. In those cases, she usually recommends blepharoplasty—a surgical procedure that involves tightening the under-eye area by removing sagging skin, muscle, and/or fat—instead.

So if you’re interested in managing dark circles under your eyes, the first step is to talk to a board-certified dermatologist to diagnose what’s actually causing the issue. And, remember, it may be due to a combination of factors, like hyperpigmentation coupled with anatomy and lifestyle factors (like dehydration and sleep deprivation, as we mentioned earlier). In those cases, your dermatologist may recommend the best under-eye filler, a chemical peel (a Mesopeel is a popular option for under-eye circles since it fades hyperpigmentation without causing irritation), or any number of treatments.

The benefits of fillers for under-eye wrinkles or dark circles include brightening of the skin and restored volume under the eyes, Desmond Shipp, MD, board-certified dermatologist and director of cosmetic dermatology at The Ohio State University Wexner Medical Center, tells SELF. Under-eye fillers can address wrinkles and fine lines and, because they fill the hollowness under the eyes, they can even out the sunken appearance of the under-eye area, adds Dr. Shipp.

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What’s the difference between under-eye fillers and Botox?

Before you delve further into the best under-eye filler for your specific dermatological goals, let’s discuss your options, namely hyaluronic acid fillers like Juvederm versus Botox.

“Botox is a neurotoxin that works to inhibit your muscles from contracting, thus helping to relax the overlying skin, and giving a smoother, more youthful appearance,” says Dr. Shipp. In other words, it’s for targeting fine lines to achieve a more “relaxed” look. You can see results as soon as 72 hours after the procedure, and the injection will typically last up to 90 days, he adds.

Getting Juvederm under the eyes is a different scenario: It’s a hyaluronic acid filler (the most common kind) that’s injected directly under the skin to fill in space, rather than affecting the muscles. You can expect a more immediate result of less hollowness from Juvederm, and it’ll last longer than Botox—about nine to 12 months, according to Dr. Shipp.

Source: SELF

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