Facial Hollowness & Under-Eye Dark Circles
Facial hollowing and periorbital dark circles are multifactorial concerns. At PRP London Clinic, our clinical approach—overseen by our Medical Director and led by our board of GMC-registered specialists—involves a detailed assessment of the skin's anatomy.
Content Author & Reviewer
PRP London Clinic Medical Team
GMC-Registered Medical Professionals
Our team of GMC-registered medical professionals collaboratively review all medical content to ensure clinical accuracy and provide evidence-based information for patient education.
Dr Mohammad Akbar
Founder & Medical Director
Dr Mohamed Nafei
GMC-Registered Aesthetic Doctor
Dr Severine Leonet
GMC-Registered Aesthetic Doctor
Dr Reem Nouri
GMC-Registered Aesthetic Doctor
Last reviewed: December 31, 2025
About Facial Hollowness & Under-Eye Dark Circles
Is This Treatment Right for You?
Ideal Candidates
- •Individuals with Grade 1-3 Tear Trough Deformity (hollow shadows under the eyes).
- •Patients experiencing mid-face volume depletion or temporal hollowing.
- •Those with vascular dark circles where thin skin makes underlying vessels visible.
- •Individuals seeking immediate structural correction (HA Fillers) or those preferring a 100% natural, autologous approach (EZ Gel).
- •Patients looking for a refreshed, 'rested' appearance rather than a dramatic surgical change.
- •Individuals with healthy skin elasticity who do not yet require surgical intervention.
Clinical Contraindications
- •Anatomical Contraindications: Individuals with Malar Edema (chronic puffiness) or Festoons, as any injectable material can exacerbate fluid retention in the area.
- •Structural Limitations: Patients with severe skin laxity or significant 'fat pads' (eye bags) where surgical Blepharoplasty is the clinically indicated gold standard.
- •EZ Gel Specific: Individuals with active hematological disorders, platelet dysfunction, or those unable to undergo a standard blood draw.
- •HA Filler Specific: Individuals with a known hypersensitivity to Hyaluronic Acid or lidocaine.
- •General Medical: Pregnant or breastfeeding women, or those with active infections/inflammation in the periorbital region.
- •Clinical Integrity: Individuals with unrealistic expectations who seek an 'overfilled' look that compromises natural facial harmony.
Shadows vs. Pigmentation: The Clinical Distinction
The most common mistake in under-eye rejuvenation is treating vascular shadows as if they are pigment.
- Vascular Shadows (Skin Atrophy): Caused by skin thinning revealing the underlying vascular bed. This appears purple or violet, mostly concentrated at the inner canthus (inner angle of the eye). This requires treatments that build collagen and remodel the vascular bed: Sylfirm X collagen protocols, Polynucleotides, Sunekos, or PRF.
- True Pigmentation (Surface): Caused by melanin overproduction. This appears in shades of brown and is determined by genetics and sun damage. This requires pigment suppression and removal: Sylfirm X pigment protocols, PRP injections, and prescription-only topical agents.
Ready to find your treatment path? Take our quick 3-question self-assessment.
Categorisation of Under-Eye Concerns
| Category | Appearance & Cause | Treatments |
|---|---|---|
| True Pigmentation | Brown shades; Melanin overproduction. | Sylfirm X, PRP, Peels, Topicals. |
| Skin Atrophy / Vascular | Purple/Violet; Dermal thinning. | Sylfirm X, Sunekos, Polynucleotides, PRF. |
| Volume Depletion | Hollowness; Loss of fat pads. | PRF Biofiller, HA Filler, or Surgery. |
Treatment Selector: Which Path is Right for Your Anatomy?
| Concern | Path | Reason |
|---|---|---|
| Pigmentation (Brown) | Sylfirm X + Topicals | Pigment suppression |
| Vascular (Purple) | Polynucleotides / Sylfirm | Thickens dermis |
| Mild Hollowing | PRF Biofiller | Natural regeneration |
| Deep Hollows | HA Fillers | High-density lifting |
| Fat Bags | Blepharoplasty | Surgery required |
Biofiller vs. Traditional Fillers: The Comparative Guide
| Feature | EZ Gel | HA Filler |
|---|---|---|
| Composition | 100% Autologous | Synthetic HA |
| Goal | Regeneration + Volume | Structural Lift |
| Longevity | 3–6 months | 9–12 months |
| Tyndall Risk | None ✓ | Possible |
| Skin Quality | Improves collagen | Volume only |
| Reversibility | Natural resorption | Dissolvable |
| Chemicals | None ✓ | BDDE cross-linkers |
*Note: Many patients opt for a 'Hybrid Protocol'—using HA for deep support and EZ Gel for skin rejuvenation.
The Clinical Consultation: How We Diagnose
At PRP London Clinic, we don't just sell treatments—we diagnose patients. Our medical team uses a combination of Visual Palpation and Anatomical Assessment to determine the 'Vector of Volume Loss' in your face.
- Step 1: We assess whether your concern is shadow-based (structural) or pigment-based (surface).
- Step 2: We evaluate the depth and location of volume loss using the tear trough grading scale.
- Step 3: We check for contraindications such as malar edema, festoons, or skin laxity that would make injectables inappropriate.
- Step 4: We create a personalised treatment plan—which may include a single modality or a combination approach.
This diagnostic-first philosophy ensures you receive the treatment that will actually work for your anatomy, not just the most popular or profitable option.
The Science of Choice: Synthetic vs. Autologous
Every face is different. Synthetic HA Fillers are medical marvels of 'cross-linking' technology, designed to stay exactly where they are placed for up to a year. EZ Gel Biofiller is a marvel of regenerative medicine, designed to integrate with your tissue and stimulate your own collagen. Our diagnostic protocol helps determine the optimal material—whether synthetic cross-linked HA or autologous EZ Gel—based on your specific tissue rheology and anatomy.
Premium Hyaluronic Acid: Structural Precision
For patients requiring structural lifting, we utilise FDA-approved, cross-linked Hyaluronic Acid (HA) from world-leading laboratories like Teoxane and Allergan. These gels are engineered with specific rheology (viscosity and elasticity) to mimic the natural feel of facial fat pads, ensuring long-lasting correction without migration. Our practitioners are trained in advanced cannula techniques to minimise bruising and ensure precise placement in the deep fat compartments.
The T-Lab™ Standard: Precision Regenerative Medicine
For regenerative treatments, we utilise the T-Lab™ PRF system, a Class IIB Medical Device. Unlike generic tubes, T-Lab uses micropolishing technology to prevent platelet aggregation. We follow a strict Precision-Optimised Centrifugation protocol to isolate clean I-PRF, ensuring a 100% activator-free bio-matrix that stimulates Type I and III collagen.
Safety Protocols for Periorbital Injections
The under-eye area is highly vascular. Regardless of the material chosen—HA Filler or EZ Gel—our clinic prioritises safety by utilising micro-cannula techniques wherever possible to minimise bruising and protect the underlying anatomy. Our practitioners are experts in periorbital mapping to ensure safe, natural-looking results.
Why Choose PRP London Clinic for Under-Eye Treatments?
Our clinic specialises in periorbital rejuvenation with a diagnostic-first philosophy:
- Institutional Oversight: All treatments are overseen by our Medical Director and performed by a board of GMC-registered specialists.
- Dual-Modality Training: Our practitioners are expert in both HA filler techniques AND regenerative protocols.
- Diagnostic-First Approach: We identify the root cause before recommending treatment—not the other way around.
- Premium Products: We use FDA-approved HA gels (Teosyal, Juvederm) and Class IIB medical devices (T-Lab).
- Safety-Focused Techniques: Micro-cannula insertion and periorbital mapping minimise risk in this delicate area.
- Honest Referrals: When surgery is the better option, we'll tell you—and provide a referral.
Treatment Process
At PRP London Clinic, we follow three distinct clinical pathways based on your diagnosis:
1. Pigmentation Removal: For melanin-based dark circles, we use a combination of pigment suppression topical agents, Sylfirm X pigment-specific protocols, and PRP injections.
2. Dermal Restoration: For purple vascular shadows and thin skin, we use sylfirm collagen-specific protocols, skin boosters (Sunekos), polynucleotides, and PRF injections.
3. Revolumisation: - Mild to Moderate: PRF Biofiller (EZ Gel). - Moderate to Severe: HA Filler (Teosyal/Juvederm), or PRF Biofiller if HA is not acceptable. - Severe with Eye Bags/Herniation: We provide referrals for lower lid blepharoplasty (surgical intervention).
Diagnosis & Assessment
Diagnosis at PRP London Clinic follows a strict institutional protocol. Our practitioners utilise Visual Palpation and the Tear Trough Grading Scale to determine the 'Vector of Volume Loss.' This ensures a standardised, high-level medical assessment regardless of which board-registered doctor you see. During your consultation, the practitioner will examine the areas of concern—cheeks, temples, and under-eye region—noting the degree of volume loss, skin laxity, and the nature of any dark circles (e.g., due to shadowing, pigmentation, or vascularity). Your medical history, aesthetic goals, and previous cosmetic treatments will be discussed to determine if PRF Biofiller, EZ Gel, HA Fillers, or a combination approach is most appropriate for your anatomy.
Prevention & Management
Lifestyle Tips
- •Maintain a stable, healthy weight to avoid rapid facial volume changes.
- •Protect skin from sun exposure by using broad-spectrum sunscreen daily to prevent collagen degradation.
- •Ensure adequate sleep to reduce the appearance of fatigue-related dark circles.
- •Stay well-hydrated by drinking plenty of water.
- •Avoid smoking, as it accelerates skin ageing and collagen loss.
- •Manage stress levels, as stress can contribute to signs of ageing.
Home Care
- •Use medical-grade skincare products containing ingredients like retinoids, peptides, and antioxidants to support collagen production and skin health.
- •Apply eye creams specifically formulated to address dark circles, puffiness, or fine lines, containing ingredients like Vitamin C, Vitamin K, or retinol (as appropriate).
- •Gentle facial massage can sometimes help improve circulation.
Not Sure Which Treatment is Right for You?
Our 3-question self-assessment helps guide you towards a suitable treatment option. Results are educational only—your consultation will confirm the best approach.
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