By David Nazarian, MD — Board Certified in Internal Medicine
A lot of patients come to me because they are concerned about dark circles, hollowing, or bags underneath their eyes. One of the most important things I explain is that these problems can look similar, but they do not necessarily have the same cause—and that matters when deciding whether PRP or PRF is likely to help.
Before recommending injections, I first try to determine why the under-eye area looks dark or hollow.
Dark circles are not one diagnosis
Dark circles can be caused by several different factors. In some patients, allergies or chronic nasal congestion may contribute to discoloration, irritation, or frequent rubbing around the eyes. In those situations, treating the allergy component can be an important part of the plan.
Other patients have true pigment in the skin. Others have volume loss that creates a shadow in the tear-trough area. Some have thin or crepey skin, while others have prominent fat pads that create true under-eye bags.
Those are different problems, and I do not expect one procedure to treat all of them equally well.
When allergies may be contributing
If a patient has symptoms such as nasal congestion, sneezing, itching, watery eyes, or frequent eye rubbing, I consider whether allergies may be contributing to the appearance of the lower eyelids. When medically appropriate, I may first address those symptoms with treatments such as antihistamines or nasal sprays.
In those patients, I do not want to treat only the appearance while ignoring a potentially correctable cause.
When hollowing creates the appearance of darkness
Sometimes the skin itself is not especially dark. Instead, volume loss under the eye creates a depression and shadow, making the area look darker.
That distinction is important because a treatment aimed at skin quality is different from a treatment aimed at restoring significant volume. PRP or PRF may be considered in selected patients with mild hollowing or skin-quality concerns, but I do not present them as a substitute for every volume-restoration treatment.
What about true under-eye bags?
Prominent lower-eyelid fat pads can create true bags beneath the eyes. PRP or PRF does not remove those fat pads. If fat prolapse is the dominant problem, another treatment may be more appropriate.
This is one reason an in-person examination matters. A patient may describe the problem as “dark circles,” while the main issue is actually structural.
Where PRP and PRF may fit
PRP and PRF contain platelets and signaling proteins that are being studied for their effects on tissue quality, collagen remodeling, and local cellular signaling. In appropriately selected patients, some improvement may be seen in skin texture, mild hollowing, or the appearance of dark circles.
PRF also contains a fibrin matrix that releases platelet-derived signaling factors over time. In selected patients, I may favor PRF when the goal is to support tissue quality or provide subtle fullness.
Results vary, and neither treatment should be presented as a guaranteed way to eliminate dark circles.
Why I often recommend two to three sessions
For many patients, I begin with approximately two to three treatments spaced about one month apart. The goal is to provide a series of treatments while tissue remodeling takes place gradually.
I then allow time for the under-eye area to respond before deciding whether more treatment is appropriate.
When pigmentation is part of the problem
In some patients, the darkness is caused partly by true skin pigmentation. In those cases, injections alone may not be enough.
Depending on the patient’s skin type and examination, I may discuss topical treatments such as vitamin C, hydroquinone, or other pigment-modulating agents when medically appropriate. These treatments need to be used carefully around the eyes because irritation can sometimes worsen pigmentation.
My clinical approach
When a patient asks me whether PRP or PRF can treat dark circles, I usually work through several questions first:
- Is there allergy-related discoloration or frequent eye rubbing?
- Is there true pigment in the skin?
- Is hollowing or volume loss creating a shadow?
- Is there thinning or crepey skin?
- Are prominent fat pads creating true under-eye bags?
- Would PRP or PRF realistically address the patient’s main concern?
For me, the key is not simply choosing an injection. It is diagnosing the reason for the under-eye appearance and matching the treatment to that cause.
For more information about candidacy, recovery, pricing, and treatment options, visit our PRP Under-Eye Treatment in Beverly Hills & Los Angeles page.
Individual results vary. This article is educational and does not replace an individualized medical evaluation.
