Do you have unsightly dark circles under your eyes? Ever wondered why? If so, I’m sure you’d love to have a solution. Well, you’re in luck. Today, friend, we’re going to discuss the topic of infraorbital dark circles.
There are 3 reasons why you have dark circles under your eyes: pigment deposition in your skin; thin eyelid skin with prominent blood vessels; and lastly, increased skin laxity and loss of fat volume beneath your eyelids, which is usually from sun damage or just plain getting older. Because there are 3 causes, the best treatment needs to be matched with the underlying cause for your infraorbital dark circles. Topical medicines like hydroquinone, tretinoin, azelaic acid can help with pigment deposition problems; laser treatments, injectables like autologous fat transfer or filler can help with thin eyelid skin; and lastly, surgery called blepharoplasty (or eyelid trim) can be done for excess skin in the case of sun damage or aging.
Now that you have our episode’s overview, let’s go deeper.
ONE: Your dark circles are from pigment deposition in your skin under your eyes.
Do you have a history of eczema or allergies and tend to rub your eyes? If so, the rubbing could be causing post-inflammatory hyperpigmentation in your skin. That basically means that you had skin irritation, say from eczema, and the inflammation from that process damaged the melanin-producing cells, causing them to leak melanin into your skin. Which leaves a stain or dark mark in the area—the essence of hyperpigmentation. The leaked melanin is the pigment deposition in the case of hyperpigmentation.
You can also develop pigment deposition around your eyes due to birthmarks or acquired conditions, like a nevus of Ota, or if you have darker skin, you can develop a condition called acquired idiopathic patterned facial hyperpigmentation. All of these conditions can cause pigment deposition in your skin. How do you know tell if it’s pigment deposition? Look in the mirror, and stretch your lower eyelid skin and if the dark circle doesn’t get lighter or it even looks worse, this is likely your issue.
TWO: Dark circles under your eyes are a result of your lower eyelid skin being thin, or because the blood vessels under your lower eyelids are large and prominent. There are likely genetic reasons for this issue more than anything else.
In this case, if you stretch your lower eyelid, and the color becomes more noticeable but looks dark purple, then your problem is likely thin skin and prominent blood vessels.
THREE: Your dark circles are a result of skin laxity (or stretchiness) which tends to happen with aging and long term sun exposure. It can also happen from the loss of the fat under your lower eyelid, creating what’s called a tear trough. Generally speaking, increased skin laxity and reduced eyelid fat happen aging, even if you’re really careful with sunlight exposure. You are more likely to have this as your issue if you notice a depression between the middle part of your lower eyelid and cheek, or if this problem has developed in older age. Often if this is the reason for your dark circles, you may notice pseudo bulging of the fat as well—it’s not true fat bulging because the fat is actually reduced, but its redundancy in the extra lax skin.
Okay so, now that you’ve identified what’s causing your dark circles, let’s talk about how to fix it!
If your issue is pigment in the skin, you have a lot of options, including creams, peels and laser treatments. A bleaching cream we commonly use is called hydroquinone, as it puts a block on the main enzyme that makes the pigment in our skin. This used to be available over the counter but it’s getting harder to find now, mainly because there have been reports of mercury contamination with over the counter HQ. If you want this medicine, you’ll need a prescription from your dermatologist. HQ can work within 6 weeks. In general it’s tolerated okay but this cream can sometimes cause redness or irritation and if overused can actually worsen the pigment deposition problem. Another good option is a topical form of vitamin A, called a retinoid. The results here take longer to see - often times up to 6 months - but this cream has added bonuses too, including stimulating collagen synthesis and masking fine lines and wrinkles. These are available as prescription as “retinoids” or over the counter as retinols and should be used at night because sunlight inactivates them. Main side effects of retinoids include dry skin, irritation, and increased sensitivity to sun light. Other topical options include azelaic acid (which is available in some OTC products in low strength) and kojic acid—I wouldn’t choose more than 1% of this ingredient.
If you want to be a bit more aggressive in treating the problem, see either a cosmetic dermatologist or a plastic surgeon for TCA peels or glycolic acid peels. Also you could consider laser treatments like QS ruby, QS alexandrite, NdYag or fractional resurfacing procedures. The NdYag laser has the added bonus of potentially being able to treat more noticeable blood vessels as well.
With all of these procedures, risks are greater for those who have darker skin types at baseline—you run the risk of worsening hyperpigmentation or possibly loss of your skin color. Please make sure to weigh this risk with whomever is doing your procedure before doing it, or consider asking for a spot test.
TWO: If your issue is having thin skin or more noticeable blood vessels at baseline than in general, I’m sorry to report, but creams aren’t going to be the best answer. Don’t waste your money! Instead, you may need what’s called an autologous fat transfer (meaning the doctor transfers some of your own fat) just underneath the skin and above the muscle so that your blood vessels can’t be seen through the skin. Fillers like hyaluronic acid are also an option, though as noted by the authors in the study that I’m referencing, there is actually a risk of increased pigment after HA injections. The tricky thing about filler in this area too is that if it’s placed too high, it can look like beads underneath the skin, but if it’s placed too low, it won’t cover the blood vessels and decrease the dark circles as you were hoping. NdYag laser treatments are also an option for the more prominent blood vessels too, as mentioned above.
THREE: If your issue is shadowing due to skin laxity/aging or loss of the SQ fat under the eyelid, then your best options are either laser treatments, filler injections, or a surgery to reduce the amount of lower eyelid skin, called a blepharoplasty. This is actually a very effective way to solve the problem.
Beyond surgery, there are less invasive procedures like lasers that can tighten the skin; ablative lasers, or those that remove the top layer of the skin and part of the second layer of the skin, are great at doing this, but they carry a higher risk of side effects including scarring and discoloration. Other lasers may be safer, like the diode, NdYag, Erbium glass or even fractional resurfacing. Fillers like hyaluronic acid might be useful here because they would replace the volume, or the fat, that you lost with aging. Just like before though, whomever is placing the filler needs to be expertly trained to place it in the correct location — we don’t want it too superficial as it may look like beads under the skin.
One final note: this article did NOT highlight over the counter eye cream as a main treatment option for dark under eye circles. More tried and true options are those that we talked about and likely are a better bang for your buck.
Reference
Roh MR et al. Infraorbital dark circles: definition, causes and treatment options. Dermatol Surg 2009; 35: 1163-1171.
(PHOTOGRAPH REFERENCE: Roh MR et al. Infraorbital dark circles: definition, causes and treatment options. Dermatol Surg 2009; 35: 1163-1171.)