Dark circles make a person look older, stressed and tired (no matter how you feel). There are three causes of dark circles. The most common cause in my experience is what we call “shadowing.” Most light comes from above, so any protuberance above the “dark circle” will cause a shadow and thus the complaint of dark circles. Most often the offending protuberances causing the shadow are “bags” under the eyes. These are actually fat pads which have herniated forward into the overlying muscle and skin. The treatment can actually be non-surgical or surgical. The surgical treatment is to remove the fat through a small incision either in the skin or on the inside of the lid. The latter leaves no scar, but excess skin cannot be removed by that approach. Your plastic surgeon will decide which is indicated. The non-surgical method is to inject and fill the dark depression under the fat pad with a filler, such as Restylane, Sculptra, or another indicated filler. With this depression filled, there is no shadow from the fat pad.
The second cause is from the dark blood pigment, known as hemoglobin that has leaked out of the red blood cells in the capillaries and into the very thin skin. The hemoglobin turns into hemosiderin which oxidizes when exposed to ultraviolet light, and this turns a bluish red color. This is more difficult to treat and is unaffected by topical creams that reduce melanin, such as hydroquinone. Peels, such as 35% TCA (trichorolacetic acid) can be helpful, but are usually disappointing. We are now trying Croton oil peels and the IPL laser and are hopeful that results will be more satisfying. Topical creams or serums such as New Youth Fade should also be used to reduce any excess melanin present that could add to the darkness.
The third cause of dark circles is excess pigmentation, or more specifically, melanin which is produced by our cells called melanocytes. This can be reduced by both peels and topical creams or serums with hydroquinone or other ingredients such as Kojic acid. However, both retinol, retin A, and vitamin C do have some lightening properties. Chemical peels are also effective in lightening excess melanin in the tissues. Peels do just as the name says—peel the top layer from the skin. Also think of it as removing the protective layer. So, when a peel is performed, it should be accompanied with a good professional skin care program that offers skin protection, or the excess pigment will return. Our choice is New Youth Skin Treatment System.
To treat dark circles, your plastic surgeon must be prepared to evaluate all the various causes and treat it accordingly.
E. Ronald Finger, M.D., FACS
Finger and Associates Plastic Surgery Center, PC