Dr. Brian Stolley says, in my experience, the words ‘you look tired,’ are the ones no woman wants to hear. Yet I hear numerous patients using them to describe their appearance; even after a good night’s rest.

A recent conversation with a patient Christiane, inspired me to develop a new series of treatments. During her consultation at MediSpa Maui, she indicated to one of our patient care coordinators she felt crushed when she returned home from a holiday in Maui. The first thing a friend of hers said after her month long vacation was, ‘you look exhausted.’

Why? Because Christiane, like many women her age have dark circles under her eyes that no amount of make-up or sleep can disguise. According to Christiane, ‘they’ve worsened over the years.’

Now at age 59, she’s convinced the first thing people notice about her is not her big green eyes, but the baggish purple shadows under them.

Christiane is not alone. When a world renowned cosmetic company surveyed 13,000 of its consumers, 53 percent said under-eye circles and puffiness were their chief aesthetic concern.

Apart from applying the best cosmetic concealer, women with under eye concerns typically try just about every potion, massage technique or gadget available.

I have even had patients (and staff) apply an over the counter medication intended for more “therapeutic” effects . Apparently, supermodels use this particular cream on their puffy eyes because of its supposed anti- inflammatory effects.

As a cosmetic dermatologist, I believe it often requires multiple modalities of care to treat the common conditions associated with chronological aging. Which is why I developed a technique that uses not one, but three non-surgical treatments to improve upon the appearance of dark circles. This treatment uses Ulthera’s ultrasound technology, fillers and Botox.

The eyes are typically the first place on the face people look. It’s said that most do not initially notice a woman’s smile lines. Why? They are drawn to yours eyes. If your eyes look tired, subconsciously, people assume you are tired, too.”

“Though a lack of sleep may add to the dehydration of your skin and leave your dark circles more noticeable, the amount of shut-eye you get has little to do with dark circles,” says plastic surgeon Dr. Carlo Honrado.

The cause is often associated with skin type. In pale skin, dark circles are often a purplish-red colour and are caused by blood vessels showing through the skin.

‘Skin under the eyes is thin and doesn’t have oil glands or hair follicles,’ says Dr. Honrado. ‘That’s why in fair skinned people’s blood vessels tend to show through, resulting in a purplish appearance.’

Other causes are increased pigmentation, particularly in people with olive skin. This type is most often genetic.

Dr.’s Orders

Ulthera’s ultrasound technology is the only non-surgical treatment approved by the stringent U.S. Food and Drug Administration (FDA) to help treat dark circles and sagging.

In a study published last year, all subjects reported a tightening of the skin and improvement in their dark circles after it.

In this tri phased treatment, we begin with a detailed aesthetic evaluation which helps Dr. Stolley and his aesthetic nurses to determine the treatment protocol. Typically, he suggests beginning with Ulthera.

The treatment of ultrasound energy, is focused and delivered across the brows, under the eyes and temple region. The procedure is prescribe and can be performed in as little as 45 minutes and is performed by our nursing staff.

Though there are possible side effects – welting, bruising, swelling and redness – most patients leave with little evidence the procedure was performed.

Two weeks later, patients are again assessed by Dr. Stolley. At this time he renders the second and third phases of the treatment: fillers and Botox. These treatments are administered on the same day.

First, the fillers. Dr. Stolley may inject Vobella, the thinnest form of hyaluronic acid filler, into the tear trough. Vobella is injected intrademally, into fine lines and is intended to hydrate. Which makes it ideal for the dehydrated areas of the eyes. If volume restoration is required he may use another hyaluronic acid filler or another type of injectable called, Sculptra. After the selection of filler and quantity of syringes are determined, the procedure is performed. The treatment takes about 30 minutes and this includes the time Dr. Stolley uses to softly massage the filler around the eyes. The effect is immediate.

Dr. Stolley will then progress to the final treatment. He will use Botox to treat the muscles that surround the eyes.

‘This helps elevate the brow and also decreases the appearance of crow’s feet,’ Dr. Stolley says.


The Botox and filler make an almost immediate difference in the darkness and wrinkling. Most patients experience optimal results within 14 days.

The real improvements, while they begin immediately after the Ulthera treatment, take approximately three months to manifest. Ultimately at six months the darkness and wrinkles around the eyes are dramatically reduced.

Though the Botox will last only three months and the filler up to one year, the effects of the Ulthera will continue to increase collagen production for up to sixteen months. While it won’t halt the ageing of your eyes, it will certainly slow it down.