What to Do About Those Dark Circles
Under Your Eyes

The presence of dark circles below the eyes is a common complaint often accompanied by a high degree of frustration. Anatomical causes: Eyelids: In some patients, darkness below the eyes may be the result of shadows cast by bulging fat in the lower eyelids. The convexity of the bags blocks overhead light and creates an appearance of discoloration. Excessive fat can be sculpted conservatively with lower eyelid blepharoplasty. In the majority of patients, however, dark circling is related more to cheek than eyelid problems.

Cheek:

Hollowing located just below the eyelid may be caused by inadequate bone projection with associated descent of the cheek muscles and surrounding fat pockets. As the soft tissues of the upper cheek drift downward, the outline of the rim of bone just below the eye may become partially visible. This area of concavity prevents light from properly illuminating the skin, again creating shadows.

If the depression is more than mild, a midface lift with or without placement of a synthetic implant may be indicated. Such work is best done by a facial plastic surgeon rather than an eyelid specialist.

Some patients may benefit from the injection of filler materials into these grooves (tear trough) on the upper cheek. A variety of natural and artificial fillers are available, including liposuctioned fat. Permanent synthetic fillers can be risky since overcorrections and lumpiness are difficult to correct.

Pigmentary causes:

Often, substantial discoloration is not caused by tissue bulging or cheek hollowing alone but rather by a true increase in the amount of skin pigment (melanin). By far, the most common cause is pure and simple heredity.

Any irritant that causes chronic tissue swelling may also contribute (allergy, fluid retention, thyroid disease, kidney disease, eyelash infection, habitual rubbing, excessive sun exposure, metabolic imbalance, certain medications such as birth control pills, and so on). In cases of increased melanin production, blepharoplasty surgery will not improve (or aggravate) the discoloration.

Bleaching creams, solutions, and gels (hydroquinones) interfere with the formation of new melanin and may be helpful. Applied once or twice daily, they are available in a variety of brands and strengths (over-the-counter or by prescription) and may cause superficial skin and eye irritation. The simultaneous use of a topical cortisone cream, retinoic acid (Renova, Retin-A), and a sunscreen may be indicated. Since improvement will appear only gradually over several months, many patients give up on treatment before ever noting any result. Your best source of information is a dermatologist.

Since a common "side-effect" of eyelid chemical peel is a slight loss of skin pigment, some practitioners recommend chemical peels or laser resurfacing to treat over-pigmentation. The limitation here is that the lightening effect of peeling agents and the laser is not fully predictable (particularly in darker complexioned patients, the very group that most commonly suffers from dark circles). If your skin tone is fair, however, you may wish to consider a medium-depth TCA peel.

What else is available? Just the safest, cheapest, easiest, quickest, and sometimes most effective method of all: cosmetics. Once you've ruled out any medical cause for over-pigmentation or an obvious anatomical problem, you may wish to give low-tech a try.

A quality concealer (Dermablend, Covermark, etc.) can do wonders for dark circles. Another trick is make use of a light highlighter such as an eraser stick to blunt the demarcation between normal and dark skin and then cover the whole area with a regular foundation. Before heading off in search of surgery, a consultation with a good cosmetologist can be a worthwhile preliminary step.

More Feature Articles