Dark undereye circles are one thing we all wish we could get rid of. They are a common and frustrating problem, hard to camouflage and even harder to eliminate. Most patients have a combination of varying types of dark circles, with varying causes that need to be addressed. Luckily, we do have options for treatment.
Infraorbital fat pad protrusion or “eye bags”
For severe fat pad prominence, blepharoplasty or surgical fat pad removal is the best and only solution available. Lower eyelid blepharoplasty allows removal of the fat pad without an externally visible scar. This is generally performed by a plastic surgeon or dermalogical surgeon.
If the fat pad protrusion is mild with tear trough prominence, injectable hyaluronic acid fillers such as Restylane or Juvederm may be used. When injected into the tear trough area these fillers help to decrease the appearance of the protrusion of the fat pad.
If the under eye “bags” come with loose skin, then tightening procedures such as Ulthera (ultrasound) or Thermage (radiofrequency) can provide some benefit. While these are not a replacement for surgery, they are ideal for those who are not candidates for or who do not wish to undergo surgery. These procedures are done in- office with no down-time and very minimal risk. Results from these procedures generally take 4-6 months.
Infraorbital edema or “puffiness”
The skin around the eyes is very thin and sensitive to fluid retention. Factors contributing to puffiness include seasonal allergies, sinus infections, crying, water retention from high blood pressure, or excessive consumption of high sodium foods.
Seasonal allergies and sinus infections can be treated with over-the-counter allergy medications or prescription medications. Switching sleeping positions can also help as side or stomach sleepers can aggravate fluid retention through gravity. Sleeping on your back and adding an extra pillow can reduce puffiness. Patients should also avoid rubbing their eyes, sleeping in their makeup, or using harsh cleansers or products that irritate the eye area. Any irritation will cause fluids to pool. Ice packs, cucumber slices, chilled tea bags, or any anti- inflammatory compress will help to constrict vessels and lessen puffiness.
Sudden onset of puffiness or fluid retention can also be a sign of an underlying medical condition. Thyroid, cardiovascular, or kidney problems can cause sudden onset of edema and will need to be evaluated by a primary care doctor.
Periorbital hyperpigmentation or “dark circles”
The thin undereye area is very prone to hyperpigmentation due to a range of factors such as genetics, rubbing, irritation, and inflammatory skin diseases. Patients should be advised to avoid chronic rubbing of the eye area which can lead to dark, thickened undereye skin. Skin lightening creams containing ingredients such a hydroquinone (Neocutis Blanche), azelaic acid, kojic acid, and glycolic acid, along with small doses of retinoic acid (Topix Retinol Eye Repair Cream), can be successful in lightening this pigment. Caution should be used when applying these products so as not to increase irritation. In- office treatments such as light chemical peels or laser treatments such as IPL or Q-switch YAG can be effective as well.
Infraorbital tear trough depression or “hollowing”
Loss of volume around the eye area exposing the orbital bone can lead to hollows which show up as dark circles. Often due to genetics or significant weight loss, these hollows can best be treated with a small amount of hyaluronic filler such as Restylane or Juvederm to fill in these troughs. These injections are highly technical and should only be administered by a skilled injector.
Periorbital vascular prominence or “veins”
As we age, the skin around the eye area becomes thinner, exposing small capillaries and veins just below the epidermal layer. This can lead to a bluish undertones or can cast dark shadows. Eye creams containing caffeine, such as Obagi ELASTIderm Eye Complex Serum, can help to constrict vessels and temporarily diminish these shadows. Small capillaries and larger blue veins can sometimes be treated with vascular lasers.
Periorbital static and dynamic rhytids or “wrinkles”
Botulinum toxin such as Botox or Dysport, placed in small amounts around the eye area will reduce wrinkles. Laser treatments such as the Madonna Eye Treatment or the heavier erbium Co2 will help to resurface and soften these lines.
What you can do at home…
In general, patients dealing with undereye circles should use makeup to help conceal or mask the eye area. A mineral makeup concealer such as Jane Iredale or Teamine Concealer, that matches or is slightly lighter than their skin tone is ideal. All patients should be advised always apply sunscreen around the eye area such as Colorescience Sunforgettable Eye Screen and to make lifestyle changes such as quitting smoking to prevent further breakdown of this delicate eye area. An eye cream, such as Skin Medica TNS Eye Repair or Neocutis Lumiere, should be applied on a daily basis to keep the area moisturized and healthy.