If you’re like my wife, you either complain about the dark circles under your eyes or you know someone that complains about the dark circles under their eyes! There are several ways to treat this, some better than others. But before you can treat it, you have to understand why you have the dark circles. Understanding the underlying cause will help you and your plastic surgeon find the best treatment.
Most patients I see automatically think that the dark circles are from allergies or small blood vessels called capillaries just underneath the skin. While allergies may be a cause and can often be treated with over-the-counter allergy medication (Allegra, Claritin, etc), the assumption that it’s caused by capillaries is probably the least common problem. I find that far and away the most common cause of dark circles under the eyes is…..a shadow! That’s right. As you age, even as young as the 20’s and 30’s, your lower lids can have a sunken appearance due to the underlying bony structure of your face. This results in your eyes casting a shadow on the lower lids. So how do you treat this most common cause of dark circles? I recommend a filler to my patients. If done appropriately by a board certified plastic surgeon, this can be very effective. If the underlying bone and lower lids are sunken in below the eyes, then you can correct this by injecting a filler like Juvederm®, Belotero® or Radiesse® under the muscles that surround the eye socket, along the bone, and this will push out the under-eye skin, bringing it out of the shadow of the eyes. Here’s an example:
Short of injecting a filler, what topical treatments can be used? For patients that have dark circles due to skin pigmentation from the underlying orbicularis muscles that surround the eye, there are several ways to lighten the skin. I regularly use hydroquinone which is a bleaching agent. It’s a prescription cream that insurance does not cover. It reduces the amount of melanin produced by skin cells, thus lightening the eyes. However, long term use has been shown to have a paradoxical, or opposite effect of what you’d expect…it can lead to darkening of skin with prolonged use. For this reason, several companies have come out with hydroquinone-substitutes.
Niacinamide can be found in the Skin Firming Serum made by Rx Skin Therapy. These topical ingredients “brighten the tender skin under the eyes,” according to Kristen Riddle, compounding pharmacist and Founder of Rx Skin Therapy. “The combination of Niacinamide, which is in the Skin Firming Serum, and retinol & retinyl palmitate, which is in the Retinol Complex, help to fade freckling and age spots.”
For those patients that still have dark circles, even after filler treatment or creams that lighten the skin, the next topical treatment to try are those to correct sun damage. For sun damage, topical antioxidants work great. But a skin cream that contains antioxidants isn’t enough by itself. For adequate absorption into the skin, the topical cream needs to be formulated with the correct pH balance. According to Riddle, “pH is so important for all skin care products/ingredients’ efficacy and skin penetration”. Without the correct pH, a topical cream with antioxidants will not be absorbed and therefore not repair sun-damaged skin. In addition to pH balance, she recommends topicals that contain caffeine since it brightens the under eye area and minimizes puffiness.
If after these non-surgical treatments your dark circles haven’t improved, you can speak with your plastic surgeon about minimally invasive techniques to remove excess skin or excess fat from baggy lower eyelids that may contribute to dark circles. These treatments are very individualized and as with any procedure, have associated risks, so be sure you seek out a board certified plastic surgeon to help you through your journey.