Dark circles can occur at any age and bother the patient especially from an aesthetic point of view.

The periocular area changes over the years, including fine lines, skin discoloration, grooves under the eyes or bags around the eyes and is due in part to the loss of volume in this area (both bone tissue and muscles and adipose tissue changes as we age) and may be due to other factors such as lifestyle, vitamin deficiencies, lack of proper hydration, excessive sun exposure, hormonal disorders and certain diseases.

All these present changes make us age, give us a much sadder and tired look.

When we talk about dark circles we must understand that they can be of several types:

• dark circles with volume loss - we are talking about tear trough or tear ditch; when there is a clear loss of volume in the tear duct, it is recommended to fill the circles with hyaluronic acid

• dark circles associated with bags under the eyes- require special attention, and the most effective treatment is usually lower blepharoplasty. In these cases, hyaluronic acid is not injected because the bags under the eyes will be even more accentuated.

• pigmented circles without volume changes in the periocular area - a situation in which depigmentation solutions are recommended

It is important for the patient to understand that the treatment of dark circles regardless of their appearance and type is complex and longer lasting.

In order to be able to evaluate the patient and to determine what type of dark circles he presents, but also to be able to discuss what are the patient's expectations related to this procedure, a consultation is necessary first of all.

The procedure for filling the circles with hyaluronic acid is performed under local anesthesia with anesthetic cream, so that the discomfort felt by the patient is minimal and consists in injecting a small amount of acid hyaluronic with needle or cannula at the level of the tear duct.

For the periocular area, a type of hyaluronic acid specially designed for this area is used, which is much more fluid than the other types of hyaluronic acid and which does not retain water.

Knowing the anatomy of the periocular area is very important to avoid complications. The most common complications that can occur are:

Tyndall effect (bluish coloration of the area where the acid was injected - occurs when hyaluronic acid is injected too superficially)

• edema of the area

• bruising or bruising at the injection site if the injection is done with a needle

• zone overcorrection - if too much hyaluronic acid has been injected

• complications related to intravascular injection or near the infraorbital foramen - the most serious of the complications

It is preferable to use small amounts of hyaluronic acid and to make a subcorrection and after a while to reinject hyaluronic acid again. If an adverse reaction occurs or if the result of the procedure is not as expected, there is treatment with hyaluronidase, which practically melts the hyaluronic acid that has been injected.

The results begin to be visible immediately after the procedure and the remanence of hyaluronic acid at this level is about 6 months, after which the injection will be repeated.

Following the procedure of filling the circles, the eye area acquires a much more relaxed, younger appearance.

The dark circles filling procedure can be combined with other procedures to improve the overall appearance of the periocular area such as: peels, mesotherapy, medical microneedling, etc.