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Treatment of Dark Circles Under the Eyes

Written By Admin on Monday, June 17, 2013 | 9:02 AM

Effective treatment for removal of dark circles under the eyes must be directed at the underlying cause of the dark circles. Millions of people complain of dark circles under the eyes but the underlying cause of the dark circles varies greatly. Treatments for dark circles that do not correct the underlying cause of the dark circle do not work. There is an incredible array of treatments for dark circles including cucumber slices, tea bags, vanishing creams, bleaching creams, lasers, surgery, more sleep, avoid TV and computer, drink 2 liters of water a day etc, yet few of these regimens seem to be directed at the underlying cause of the dark circles under the eyes.
To better understand the treatment of dark circles under the eyes I will discuss the various types of dark circles under the eyes that I encounter in my plastic surgery practice and my understanding of the cause of the dark circles, and what I feel is the most effective treatment to remove the dark circles under the eyes.
Understand that the eyelid skin appears darker than the surrounding facial skin in all people-this is the normal condition and is caused by shadows created by the overhanging brow and the fact that the eyelid skin is much thinner than the surrounding facial skin. Below I am talking about exaggerated dark circles under the eyes that cause people to be unhappy with their appearance.
Causes of Dark Circles under the Eyes
Thin Eyelid Skin
The eyelid skin is the thinnest in the body and many people with dark circles under the eyes have extremely thin skin on their eyelids and around the eyes. This thin skin is an inherited trait. The dark circles under the eyes are caused by the fact that the purple color of the underlying eyelid muscle shows through the thin skin and creates a bluish or purple color. The color is darkest near the nose and on the lower eyelid near the nose.
Treatment of dark circles under the eyes caused by thin skin is very difficult because it is very difficult to make your inherited skin thicker. Cover up make up like Jayne Iredale Eye Cover, Dermablend, and Covermark are very helpful and my first recommendation. Frequent microdermabrasion and Retin A cream over a long period of time will build new collagen in the dermis will thicken the skin and provide some improvement.
There are new lasers on the horizon which are very effective at stimulating new growth of collagen in the dermis and these new technologies may prove very beneficial. Be sure to sign up for my free newsletter to be informed when these new technologies are available.
The Arcus Deformity discussed below creates a very severe dark circle in people with thin eyelid skin and correction of the Arcus deformity with Arcus release and fat grafting can be very helpful treatment for dark circles under the eye in these individuals.
Prominent Eyelid Blood vessels and Veins
Everyone has veins and blood vessels called capillaries in their eyelid skin. In many people however the veins are very prominent and the blood vessels add to the dark color of the eyelid.
To diagnose this cause of dark circles look in a mirror with bright light on your face and gently pull the skin of the lower eyelid tight. You will see many tiny branching red and blue lines which represent blood vessels.
You need blood vessels and veins to keep your eyelid healthy and alive. However when there is an abundance of smaller vessels which create a bluish or purplish hue to the lower eyelid some new IPL (Intense Pulsed Light) or laser therapies can be used to treat dark circles under the eyes in people with an excess of small capillaries and blood vessels. The very large veins cannot be treated.
Laser blood vessel treatment is a serious and potentially dangerous treatment for dark circles under the eyes and must be performed by a physician who is experienced in the use of lasers and IPL. Most importantly the eye must be protected by placing a shield over the eye during treatment so that the laser or IPL light cannot hit the eye. The laser and IPL light can damage the retina and destroy vision if the beams hit the unprotected eye.
Pigmentation of the Eyelids
Hyper pigmentation, too much pigment in the skin of the eyelid is a very common cause of dark circles under the eyes. Treatment of dark circles under the eyes caused by hyper pigmentation is very effective, but the pigment frequently returns after sun exposure.
Hyper pigmentation of the lower eyelids occurs because of sun exposure and prevention with sun block, sun glasses, and a hat are the most important first treatment for this type of dark circles under the eyes.
The treatment of hyper pigmentation begins with bleaching creams such as a combination of Retin A and 4% Hydroquinone, Obagi Blender 5, Epiquin or other prescription bleaching cream combined with microdermabrasion.
After the above treatments have lessened the pigmentation causing the dark circles under the eyes, if necessary I proceed to IPL (Intense Pulsed Light) treatments. These treatments do effectively remove pigment causing the dark circle but again experience and eye protection are very necessary to prevent eye injury.
Hollow Eyes
Many people have a deep hollow beneath the lower eyelid which creates a dark shadow beneath the eyelid which people call dark circles under the eyes.
This deep hollow beneath the lower eyelid is caused by an inherited deficiency of fat and or bone and treatment of this type of dark circle under the eye requires surgery.
The hollow eye occurs more commonly in people from Central Asia and the Middle East but it certainly occurs in all races and from people in all regions of the world.
To treat dark circles under the eyes in people who have hollow eyes I do a laser procedure called an Arcus Marginalis release and fat grafting. The Arcus Marginalis is a structure which tethers the lower eyelid to the bone and creates a dark circle when the eyelid skin above the dark circle falls over the dark circle creating a shadow. Releasing the Arcus Marginalis releases the eyelid skin and eliminates the crease or dark circle.
I then transplant fat to fill the hollow in the bone and plump the dark circle and correct the hollow eye appearance.
Usually, to treat the dark circle under the eyes caused by the hollow eye I have to take fat from around the belly button on the abdomen to have enough fat to adequately fill the hollow eye deformity. The incision to remove the fat is well hidden down inside the belly button and is usually not visible.
Treatment of dark circles under the eyes caused by the hollow eye usually takes me 45 minutes to an hour, can be done with you asleep or awake, and recovery is usually 10 days. Patients do not complain of pain afterwards. The main recovery is waiting for bruising to go away and blurred vision from eye ointment that I have you use for the first week or two. Most importantly after this treatment you need to be calm, rest and not exert yourself. Working out or heavy lifting can raise your blood pressure and cause bleeding. Although you will be up and around the first few days with sunglasses to cover your bruising, I do not want you to exercise or lift heavy objects for at least 2 weeks.
The Arcus Deformity-the True dark Circle under the Eye
The most common cause of dark circles under the eyes in patients who seek treatment of dark circles under the eyes in my plastic surgery practice is the Arcus Deformity.
The Arcus Deformity is a dark crescent shaped circle or depression which occurs beneath the lower eyelid starting beside the nose in the corner of the eye and running out toward the side of the face and curving upward towards the outside corner of the eye.
The Arcus Deformity is caused by the fact that a small structure beneath the lower eyelid called the Arcus Marginalis is attached to the bone of the eye socket and also attached to the lower eyelid from underneath. This attachment tethers or holds the eyelid close to the bone of the eye socket while the rest of the lower eyelid is loose and free to move. The normal fat which is beneath the eyeball pushes out against the lower eyelid which creates a visible bulge on the lower eyelid. You can see this by closing one eye and gently pressing on the closed eye. With your other eye you will see the bulging of the fat against the closed lower eyelid on the other side.
The eyelid skin that is tethered by the Arcus Marginalis cannot move or bulge, and as the fat bulges the lower eyelid above the Arcus Marginalis it creates a shadow or dark circle beneath the eyelid where the Arcus Marginalis is attached to the lower eyelid skin. This is the true dark circle under the eyes.
As we age and our eyelid skin becomes loose or lax, the eyelid skin also falls or sags over the depression caused by the Arcus deformity and the dark circle gets worse. With aging and excess protrusion of fat against the lower eyelid the Arcus deformity can become quite pronounced.
The Arcus Deformity is the true dark circle under the eye and I use the term Arcus Deformity to differentiate it from the Tear Trough Deformity which is different. The Tear Trough Deformity starts near the corner of the eye in the same location as the Arcus Deformity but the Tear Trough Deformity runs down into the cheek rather than up toward the outside corner of the eye.
The Tear Trough Deformity is a sign of advanced facial aging and is caused by the sagging or descent of the cheek into the middle of the face which occurs with facial aging in your 50's and 60's. Tears run down the cheek and out the side of the face through the Tear Trough instead of straight down the cheek as they do in a child.
By contrast the Arcus Deformity occurs in much younger patients including children. Most people seeking treatment for dark circles under the eyes in my plastic surgery practice are in their 20's and 30's. Doctors often misdiagnose the Arcus Deformity as the Tear Trough Deformity which is a major problem if a Tear Trough Implant is used to treat the dark circle. The Tear Trough Implant is designed to plump or correct the depression in the cheek out toward the side of the face, and in my experience the Tear Trough Implant cannot adequately correct the dark circle under the eye where it is deepest, near the corner of the lower eyelid near the nose.
The treatment for dark circles under the eyes caused by the Arcus Deformity must include release of the Arcus Marginalis and fat repositioning or fat grafting to plump the area of the dark circle.
The traditional plastic surgery treatment for eyelid rejuvenation called the blepharoplasty, during which fat is removed, can actually make dark circles under the eyes worse and create a hollowed eye appearance.
Treatment of dark circles under the eyes that are caused by the Arcus deformity requires a modern blepharoplasty approach which includes release of the Arcus Marginalis and fat repositioning or fat grafting.
I use a very specific treatment for dark circles under the eyes called the transconjunctival blepharoplasty with Arcus release and fat grafting. This treatment is done through a tiny incision on the inside of the eyelid called a transconjunctival incision because it goes through the conjunctiva, the pink tissue on the inside of the lower eyelid. I also use the laser to make this incision.
The benefits of the laser transconjunctival incision are:
1. No visible scar or incision on the outside of the eyelid
2. No change in the shape of the lower eyelid-the traditional scalpel blepharoplasty through an external incision usually weakens the lower eyelid and causes a sad eyed look
3. Less bleeding during surgery
4. Less bruising after surgery
5. Quicker recovery
My results following treatment of dark circles under the eyes with the laser transconjunctival blepharoplasty with Arcus Marginalis release and fat grafting have been very successful. Most patients have recovered within a week and many who do not bruise are comfortable being seen with make up after 5 days.
Summary- Treatment of Dark Circles under the Eyes
To summarize, effective treatment of dark circles under the eyes requires that you correct the problem that is causing the dark circle under the eye. To accomplish this you must understand what type of dark circle under the eye you have and what is causing it. The following is a summary table:
Thin eyelid skin-Retin A, microdermabrasion, laser?
Prominent Eyelid Blood Vessels-IPL, Laser
Pigmentation of the Eyelid-Bleaching creams, IPL, laser, Microdermabrasion
Hollow Eyes-Arcus Marginalis Release and fat Grafting
Arcus deformity-Transconjunctival laser Blepharoplasty with Arcus release and fat grafting or repositioning
Treatment of dark circles under the eyes is possible; the key is understanding the underlying cause of your dark circles. With proper diagnosis and treatment of dark circles under the eyes caused by the Arcus deformity beautiful results can be achieved with the transconjunctival Arcus release and fat grafting.

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