Dark Circles Under Your Eyes – Different Treatments For Different Causes

Dark circles under the eyes is a frequent request for treatment. The plethora of available treatments on the internet from vanishing and bleaching creams to laser surgery is a testament to the commonality of the problem. It also suggests that most of these treatments are not effective because they simply don’t work or are used on the wrong type of dark circle problem.

By anatomic location, lower eyelid skin is darker than the skin on the rest of the face because it is very thin (and can show the color of the underlying muscle) and due to shadows due to the overhanging brows. When exaggerated dark circles are present, there are several reasons why they may be there. Thinness of the lower eyelid skin, hyperpigmentation, hemosiderin (blood product) staining, deep set eyes, and the arcus deformity are the main causes.

Diagnosing which of these causes of dark circles is obviously critical to selecting what may work. In general, dark circles are hard to treat and there is no magical solution. (no matter what the marketing hype says) If the problem is thin skin, there is little that can be done to substantially thicken it. Vitamin A and C creams and pulsed light treatments may provide some improvement over time. However, camouflaging the dark with concealer or mineral makeup is the most effective and cost efficient.

Hyperpigmentation is a common cause and is particularly prone in dark-skinned individuals. It can be initially treated by topical creams that contain retin A (exfoliating) and hydroquinone (bleaching) agents. My current favorite is TriLuma cream (available by prescription) because it contains Retin A, hydroquinone, and steroids all in one. This has to be used for several months before any improvement can be expected. In very resistant dark circles, the use of intense pulsed light (BBL, Broad Band Light) may also be tried but the power setting should be low and careful eye protection done. Medium-depth chemical peels (25% TCA) can also be tried but these are also prone to induce hyperpigmentation as well. The eyelid should be treated before and after chemical peeling with melanin suppressants to avoid this potential problem.

Hemosiderin staining, byproducts of the many blood vessels in this area, can also stain the thin eyelid skin. This cause can be hard to determine. When present, it can be treated with topical creams containing Vitamin K or arnica or pulsed light treatments that use a 560nm or 590nm filters.

Deep set or hollow eyes as a cause of dark circles requires a surgical solution. The bone on the lower rim of the eye is deficient or flat causing the lower eyelid to indent in. This pulls the lower eyelid in, exaggerating the natural shadowing effect. The area under the eyelid must be built out using either fat grafts, orbital rim implants or fat transposition. Lower eye lid fat transposition is the simplest and most reliable method. By releasing fat from underneath the eye and bringing it out over the rim of the bone, the lower eyelid is better supported and the depth of the hollow is decreased. (as well as the shadowing) Implants also bulk up the bone but the thin skin of the lower eyelid may make it possible to feel or even see it. Free fat grafts are soft but unreliable as to how much will survive after surgery.

The arcus deformity is an often undiagnosed dark circle cause. It is caused by an abnormal attachment of the lower eyelid to the bone which makes the lower half of the eyelid dip in while the upper half is loose and filled with fat which bulges out from under the eye. As one ages, this lower eyelid look worsens creating darker and darker circles. This arcus deformity can be released through a transconjunctival (inside the lower eyelid) approach, allowing fat to balloon out the dark circle area. In some cases, fat grafts can be added as well.

As one can see, there are numerous causes of dark circles and this accounts for why there are so many espoused topical treatment solutions…..but none of them really work. Improvement in dark circles of the lower eyelid is possible but identifying the cause is critical…something internet products do not do.

Time Management, The Key To Effective Study

How To Buy The Best Real Estate Property For Investment