Dark circles under the eyes?

October 28, 2019 / Duncan Fisher
Know your treatment options.

We ran across an article recently in a popular women’s magazine, about dark circles under the eyes, and what dermatologists recommend doing about them.

What the article said was reasonable enough, as far as it went. But the advice it gave was pretty superficial, and it wasn’t complete, and, as is often the case in magazine articles, the advice soon reduced to what skin care products to buy.

Dark circles can be caused by a lot of things, and the armamentarium for treating them varies enormously. If you don’t treat them, nothing bad will happen. But if you do want to treat them, we thought we’d better offer you a medical rundown – a complete one – of what dark circles really are, and the range of things that can be done about them.

We won’t tell you what to buy, but we will tell you how to talk to your dermatologist.

The various causes of dark circles

Your doctor calls all of this darkening ‘periocular’ or ‘infraorbital’ discoloration.

It can simply be a function of your facial anatomy – your bones, your midface muscles and vasculature, your ligament architecture, and the thickness of your eyelid skin and underlying tissue.

Bones and ligaments are probably the most important of these things, because they comprise the primary load-bearing structure of your facial fat compartments. When you age, your orbital rim recedes and you lose a little bone volume. Ligaments tighten, facial fat descends, and you get a subtle facial hollowing, which can result in shadowing in the tear trough below your eyes.

Ageing changes your midface soft tissue as well. You lose fat, your muscles lose mass, and you lose volume in the ‘fibroadipose’ tissue below your eyes.

Finally, eyelid skin is thin, and pretty translucent. It doesn’t conceal changes beneath it, and it goes through age-related changes of its own. So, for skin reasons below your eyes, you can see color changes from quite a number of things, ranging through congenital causes, melasma, melanocytosis, UV light exposure, leaky veins (you have a lot of little veins under your eyelids) depositing hemosiderin, hormone changes, or medications. Sometimes it’s none of these, and the causes can be simple and transient. Those dark bags in the morning, especially after a salty meal? That’s edema, simple fluid retention, and it often takes on a purplish tint. It goes away.

Dark circles develop for lots of reasons, to sum it up, and they sometimes fluctuate, all because of many possible skin and under-skin changes.

The treatment options

Topical

To stay non-invasive, you can use concealers and cosmeceutical preparations. Mineral makeup is the first stop, and you experiment with hues to reverse color irregularities.

There are ‘optical diffusers’, made of micro-ionised refractive particles that scatter light in the skin.

You can ask your doctor about retinoids, vitamin A derivatives. These decrease melanin content in your skin, and encourage the building of more collagen bundles, which helps the bagginess.

Hydroquinone is another option you can discuss. This is a ‘tyrosinase antagonist’, that plays a down-regulating role in the pigmentation pathway. This is a problematic treatment. Dosage is hard to get right (too much can increase your darkening), and it is subject to a lot of regulation lately because of possible cancer and toxicity connections.

Topical caffeine, believe it or not, is now under study. There is research data about it. Caffeine gel, in one recent trial, did seem to penetrate the lower eyelid skin and reduce edema and pigmentation.

Finally, there are cosmeceutical ‘peptides’. There are about two dozen formulations that exist at this point. You can ask your doctor about ‘signal’, ‘enzyme inhibitor’, and ‘carrier’ peptides. They’re increasingly common, and worth discussing. They do appear to help improve robustness in the skin.

Non-invasive

Different forms of light therapy exist. One is ‘intense pulsed light’, or ‘IPL’. This heats up and destroys haemoglobin and melanin, so it reduces pigmentation and over-veiny areas of skin.

Another is radiofrequency (or ‘RF’) treatment. Think of this as a tiny, directed electrical field, that heats up target tissue like light treatment does, only more gently. It can reach deeper into tissue layers, even down to subcutaneous fat.

Q-switched lasers, in nanosecond pulses, selectively go after melanosomes while sparing surrounding tissue. They reduce pigmentation.

Pulsed dye lasers go after haemoglobin, which is to say, they help reduce dark circles that are there for vascular reasons rather than pigmentation.

Invasive, but not surgery

Chemical peels, of various types and in various concentrations, remove melanin in the epidermis, and, if you’re aggressive with it, in the dermis.

Medical tattooing, strange as this sounds, formally called ‘blepharopigmentation’, actually puts in pigment. It migrates to connective tissue, and its goal there is to smooth areas of transitional change in pigment in the lower eyelids.

Laser ablation, or resurfacing, is controlled injury to the skin, which your body then repairs, smoothly. The idea is to reduce light shading due to skin irregularity, and also to reduce areas of pigmentation. This is not like Q-switched or pulsed dye laser treatment. The usual tool for this is the CO2 laser, or else the ER:Yag laser. It is invasive.

Hyaluronic acid fillers are another way of at least addressing irregular contours that cause shadow-darkening. It’s the treatment of choice for many people who want to reverse volume deficiencies due to ageing. The apparent lightening effect can be quite profound. The treatment can be chemically reversed, too.

Fat transfer smooths contours as well. It’s done by injection, much like hyaluronic acid filler treatment. It’s considered invasive, but patients who have it tend to like the results.

Really invasive

There is lower eyelid blepharoplasty, in various forms. Surgeons can remove fat, release ligaments, and recontour soft tissue in numerous ways to reverse age-related contour changes that play a role in dark circles.

They can also augment bone and tissue loss with tear trough and cheek implants.

The bottom line

Dark circles can be about darkened skin, or processes underneath the skin, or large structural changes across the face. If you’ve got dark circles, and you’d like them treated, talk to your dermatologist. Just as causes can vary, treatments can vary, and there’s quite a lot to discuss before you do anything.

Questions about your skin? Ask our dermatologists online for $35.