Dark Circles and Shadows Under your Eyes
This is one of the most common complaints people have: dark circles under their eyes. Sometimes this can be treated and sometimes the problem resists treatment. The first thing to determine is the cause of the darkness. Three factors can contribute to darkness under the eyes:
1 – Visible blood vessels
2 – Excess pigment
3 – Hollowness due to a deep tear trough.
Some people have one cause, some have two or even all three.
Which one do you have?
If you apply pressure to the circle or shadow and it disappears, your problem is due to visible blood vessels underneath the thin skin of the eye area. If the color doesn’t disappear, the darkness is caused by excess pigment. And if the shadow forms at the inside corner of your eye, where a tear would flow, it’s probably due to a deep tear trough (see the “before” photo above).
How do you treat each one?
Visible blood vessels are the most difficult to treat. Some doctors will use a vascular laser to destroy these vessels. I have this laser but I won’t personally use it so close to the eye.
Excess pigment can be treated with a prescription bleaching cream. But care must be taken as this is a sensitive area and the bleaching creams can be irritating.
A deep tear trough is a common cause and can be treated with a filler like Restylane or Juvederm. This is one of those procedures that gives dramatic, almost-instant results (see photos). But almost everybody gets bruising (i.e. two black eyes) that lasts for a week or so.
Other causes and treatments:
One other cause for dark circles under the eyes only occurs in patients with seasonal allergies. These people develop the so-called “allergic shiners”, which is essentially pigment caused by constantly rubbing their itchy eyes. We treat these dark circles with bleaching creams and with allergy medicine to stop them from itching and rubbing.
Finally, there are some people who have too much fat or excess skin under their eyes causing puffiness in addition to dark circles and the only treatment for this group is surgery.