DARK UNDER-EYE CIRCLES AND OTHER CONCERNS

The aging process of the face and periorbital area has been well studied. The 3 D’s of aging include:

1. Deflation
2. Descent
3. Deterioration

A circle, crescent, or indent in the lower lid area is often the focus of unhappiness with one’s eye appearance. This area, commonly referred to as the “tear trough,” makes people look “tired”. What is usually referred to as “dark circles under the eye” is commonly located in the tear trough area.

Dark circles, however, may not necessarily be related to age. Also, one needs to rule out any medical conditions that may exist such as thyroid disease.

Seasonal allergies can cause dark circles under the eyes from constant rubbing due to friction. This is often seen in other parts of the body as well.

Genetics may also play a role related to eczema and emotional issues. In addition, some people are just born with a hollow depression in the under-eye area.

More commonly though, dark under-eye circles come from aging. Hollowing or puffiness in the lower eyelid can cause shadows or transparency of the skin, allowing the dark veins underneath to show. This can happen as the fat in the lower lid shifts and the bone degrades. The other possible cause is actual discoloration of the skin not caused by shadow and fat shifting.

Sometimes, the lower lid skin just stretches enough to allow light to reflect off the underlying blood vessels. This creates the dark look and is called the Tyndall Effect.

TREATMENTS

As one can see, there are many causes of dark circles under the eyes. The cause will dictate the options for improvement.

If the problem is a hollowing that is creating a shadow or transparency of the skin (which allows the underlying blood vessel to show through), fillers are used to increase the volume in the tear trough.

If the puffiness is causing a shadow from the fat elevation, surgery to remove the fat may be the most effective option (Blepharoplasty).

In terms of treatments to tighten the skin and treat fine wrinkles and lines, ablative and non-ablative lasers are available, as are chemical peels. Radiofrequency technology has also been shown to stimulate the formation of new collagen and improve the skin’s elasticity. Lasers work by decreasing pigmentation, shrinking blood vessels, and stimulating collagen and elastin. Many types of lasers can be used, including CO2, Pulsed Dye, Q-switched, IPL (Intense Pulsed Light), and Fractional Erbium.

Of course, there are many creams and ointments on the market that can be used to target dark circles. This longer-term management is more comprehensive-addressing and is used in combination with total skin care.

I do, however, have a simple approach to skin care. That is, you need to keep your skin clean, keep your skin moist and protect it with sunblock every day. Lifestyle can also affect your skin. Heavy alcohol consumption will age the skin as will smoking. Stay well hydrated. Avoid excess sun exposure and, of course, get the proper amount of sleep. Maintain a healthy exercise routine.

Ronald W. Kristan, MD, FACS
Eye Plastic Surgery, Cataracts
Atlantic Eye

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