A common concern for both women and men is the unsightly appearance of dark under eye circles and puffiness. Like many of our physical features, these are due to our genetic makeup, but they can contribute to making us look tired and are often one of the earliest signs of aging. Despite the large number of creams and concealers available as a temporary fix, the most definitive procedure is lower eyelid blepharoplasty (eyelid lift), which removes excess skin and fat under the eye and provides a permanent solution. Eyelid lifts may be performed using an incision concealed inside the lower lid, which no visible scar. Another option is to inject hyaluronic acid (Restylane or Juvederm) into the tear trough (the crescent-shaped under eye area) to rejuvenate the appearance of the under eye area. The resultant improvement usually persists for 8 to 12 months. An alternative to fillers is the use of a patient’s own fat, which tends to produce even longer-lasting results. Soft tissue fillers and fat may not only add volume to the depression of the tear trough, but can also be used to thicken the skin and muscle of the lower eyelid, which may improve the overall appearance of the lid. Resurfacing of the lower lid skin with chemical peels or lasers can also tighten and smooth the skin in the area and create a more youthful appearance. Factors which contribute to dark circles include volume loss in the under eye area that exposes the orbital bone, the extremely thin skin in the area (which thins even more with age), dilated blood vessels (e.g. due to allergies or birth control pills), and sun exposure. In addition, the fat which normally exists in the lower eyelid may be seen to bulge, especially as the skin thins and loosens with aging, allowing it to protrude more. This also creates a shadow which can exacerbate the appearance of dark circles. Having a number of different treatment options to address the lower lid enables patients to choose which procedure they prefer. Some procedures may be combined, for example an eyelid lift may be performed concurrently with laser or acid peel resurfacing of the lower lid skin. Dr. Olivia Hutchinson is a board certified aesthetic plastic surgeon in NYC and performs under eye rejuvenation including eyelid lifts, peels and lasers in the safety and comfort of her certified Operating Room. To schedule a consultation with Dr. Hutchinson, please contact us or call us at (212) 452-1400.