Dark circles under the eyes are a frequent request for treatment. The plethora of treatments available on the Internet, from removal and whitening creams to laser surgery, is a testament to the commonality of the problem. She also suggests that most of these treatments are not effective because they simply don’t work or are used on the wrong kind of dark circle problem.
By anatomical location, the skin of the lower eyelid is darker than the skin of the rest of the face because it is very thin (and can show the color of the underlying muscle) and because of the shadows due to the protruding eyebrows. When exaggerated dark circles are present, there are several reasons why there may be. The main causes are thinness of the lower eyelid skin, hyperpigmentation, hemosiderin (blood product) discoloration, sunken eyes and arch deformity.
Diagnosing which of these causes of dark circles is obviously critical to selecting what may work. In general, dark circles are difficult to treat and there is no magic solution. (no matter what the marketing hype says) If thin skin is the problem, there is little that can be done to substantially thicken it. Vitamin A and C creams and pulsed light treatments can provide some improvement over time. However, camouflaging the darkness with a concealer or mineral makeup is the most effective and economical method.
Hyperpigmentation is a common cause and is particularly prone in dark-skinned individuals. It can be initially treated with topical creams that contain retina A (exfoliating) and hydroquinone (whitening) agents. My favorite at the moment is TriLuma cream (available by prescription) because it contains Retin A, hydroquinone and steroids all in one. This must be used for several months before improvement can be expected. In very resistant dark circles, the use of intense pulsed light (BBL, Broad Band Light) can also be tried, but the power setting should be low and careful eye protection. Medium depth chemical peels (25% TCA) can also be tried, but these also tend to induce hyperpigmentation. The eyelid should be treated before and after the chemical peel with melanin suppressants to avoid this potential problem.
The coloring of hemosiderin, a byproduct of the numerous blood vessels in this area, can also stain the thin skin of the eyelids. This cause can be difficult for BBL Surgery Video to determine. When present, it can be treated with topical creams containing vitamin K or arnica or pulsed light treatments that use 560 nm or 590 nm filters.
Sunken or sunken eyes as a cause of dark circles require a surgical solution. The bone on the lower rim of the eye is deficient or flat, causing the lower eyelid to indent. This attracts the lower eyelid, exaggerating the natural shading effect. The area under the eyelid must be reconstructed using fat grafts, orbital rim implants or fat transposition. Lower eyelid fat transposition is the simplest and most reliable method. By releasing the fat from the lower part of the eye and letting it flow over the edge of the bone, the lower lid is better supported and the depth of the recess is reduced. (as well as shading) Implants also clutter up the bone, but the thin skin of the lower eyelid can make it possible to feel or even see it. Fat free grafts are soft but unreliable about how long will survive after surgery.
Arch deformity is an often undiagnosed cause of dark circles. It is caused by an abnormal attachment of the lower eyelid to the bone that causes the lower half of the eyelid to submerge while the upper half is loose and filled with fat protruding from under the eye. As we age, this aspect of the lower lid worsens creating increasingly dark circles. This arch deformity can be released through a transconjunctival approach (inside the lower eyelid), allowing fat to swell in the dark circle area. In some cases, fat grafts may also be added.
As you can see, there are numerous causes of dark circles and this explains why there are so many topical treatment solutions married ….. but none of them really work. It is possible to improve lower eyelid dark circles, but identifying the cause is crucial … something Internet products don’t do.