Novel technique of non-surgical rejuvenation of infraorbital dark circles

Infraorbital dark circles are a common aesthetic concern which can be challenging to treat given their multifactorial nature. Under eye dark circles are seen in all skin types, with a strong familial component in darker skin types. Other major contributing factors include soft tissue and bony changes, skin changes, lifestyle contributions and allergies. Involutional periorbital volumetric changes cause volume loss in the tear trough, naso-jugal and palpebro-malar grove, skin and subcutaneous tissues with tethering of the eyelid skin to the tear trough ligament, giving a sunken and hollow appearance to the lower lid. Associated prolapse of the orbital fat and thin skin can worsen the appearance of a dark circle. Hyaluronic acid fillers placed in the pre-periosteal plane in the tear trough, palpebro-malar and naso-jugal grooves, give good results in patients with thick eyelid skin and negligible fat prolapse. However, in patients with thin skin and moderate fat prolapse, authors have reported worsening outcomes with risk of Tyndall (blue- grey discoloration) and contour irregularities from visible lumps. We describe a novel technique to improve dark circles caused by a diffuse valley type pre septal tear trough deformity in patients with thin eyelid skin. Our retrospective case review of 330 eyelids by a single surgeon shows good aesthetic outcomes with good longevity and a low risk of complications.