Category: Uncategorized

By David Nazarian, MD — Board Certified in Internal Medicine

Supporting article: This guide supports our primary PRP Under-Eye Treatment landing page and focuses specifically on which types of dark circles may or may not respond.

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.

By David Nazarian, MD — Board Certified in Internal Medicine

Supporting article: This physician-perspective article supports our primary PRP Hair Treatment & Hair Restoration landing page and focuses on response patterns and patient selection.

For the clinical treatment overview, candidacy, process, risks and pricing, see our PRP Hair Loss Treatment & Hair Restoration in Los Angeles & Beverly Hills service page.

A large number of men come to my office concerned about thinning hair or progressive hair loss. I have used platelet-rich plasma, or PRP, as one treatment option for appropriately selected patients, but one of the most important things I explain is that PRP is not equally effective for everyone.

The first question I ask is not simply whether someone wants PRP. It is: why is this patient losing hair?

Before PRP, I want to understand the cause of the hair loss

Hair loss is not always simply genetic male-pattern hair loss. In some patients, there may be other factors contributing to shedding or thinning that they are not aware of. Depending on the history and examination, I may evaluate for issues such as iron or other nutrient deficiencies, vitamin deficiencies, thyroid or hormonal abnormalities, medications, significant stress, poor sleep, recent illness, weight changes, or other medical conditions.

When appropriate, I use blood testing to look for potentially correctable contributors. My goal is not simply to inject the scalp while ignoring a problem that may be contributing to the hair loss in the first place.

Who tends to respond better to PRP?

In my experience, PRP tends to make the most sense in patients who still have viable, miniaturizing hair follicles rather than areas where follicles have been absent for a long period of time.

This distinction matters. PRP should not be presented as a way to recreate hair follicles that are no longer viable. Once an area has advanced to longstanding complete follicular loss, the likelihood of meaningful regrowth from PRP alone is substantially lower.

This is one reason I generally prefer to intervene earlier in the hair-loss process rather than waiting until the scalp has been bald for many years.

What is PRP trying to do?

PRP contains platelets and a mixture of signaling proteins and growth factors. Laboratory and clinical research suggests that these factors may influence cellular signaling around the hair follicle and may support the activity of follicles that are still present.

Scalp injections also create a local tissue response, and researchers have studied whether PRP may influence vascular signaling and blood supply around the follicle. These biological mechanisms are still being investigated, and they should not be interpreted to mean that PRP can reliably regenerate a dead hair follicle.

What matters clinically is whether a patient still has follicles capable of responding.

Hair growth takes time

One of the most common misconceptions I hear is, “When am I going to see the new hair?” Some patients expect a visible change within several weeks. Hair biology simply does not move that quickly.

Hair follicles cycle through different phases, and changes in density, thickness, or shedding generally need to be evaluated over months—not days or weeks.

I usually tell patients that early changes may take several months to appreciate, while a more meaningful assessment of response often occurs around 6 to 12 months.

That is also why I encourage patients not to judge the treatment after one month.

Why I often begin with three treatments

For many patients, my initial protocol is a series of approximately three PRP treatments spaced about one month apart, although the schedule can vary depending on the patient’s diagnosis and clinical situation.

The rationale is to provide a concentrated initial treatment period while the follicles are being exposed to repeated platelet-derived signaling factors.

After that initial series, I generally give the hair time to respond. Some patients later choose maintenance treatment at approximately six months or one year, but I do not believe that every patient should automatically be placed on the same maintenance schedule. I look at the patient’s response, pattern of hair loss, other treatments being used, and overall goals.

My overall approach

For me, PRP hair restoration is not simply an injection procedure.

• Why is this patient losing hair?
• Are there correctable medical or nutritional factors?
• Are the follicles still viable?
• Is this the type of hair loss that is reasonably likely to respond?
• Are we setting realistic expectations?
• Should PRP be used alone or alongside another evidence-based hair-loss treatment?

The patients who tend to be happiest are the ones who understand from the beginning that hair restoration is a process and that PRP is one tool within a broader treatment strategy—not a guaranteed or immediate cure.

For more information about evaluation, candidacy, treatment planning, pricing and what to expect, visit our PRP Hair Treatment & Restoration in Beverly Hills & Los Angeles page.

Individual results vary. This article is educational and does not replace an individualized medical evaluation.