Dark circles under the eyes are a frequent request for treatment. Many of the treatments available on the internet from creams and bleaches for laser surgery are evidence of common problems. It also suggests that most of these treatments are ineffective because they do not work or are used in the wrong dark circles.
With its anatomical location, the lower eyelid is darker than the skin on the face because it is very thin (and can show the underlying muscle color) and because of the shadows caused by sweeping eyebrows. When black circles are exaggerated, there are several reasons why they are there. Lower eyelid skin, hyperpigmentation, hemosiderin (blood products) staining, deep eyes, and arcus defects are the main causes.
Diagnosing the causes of these dark circles is important in deciding what works. In general, dark circles are difficult to treat and there is no magic solution. (no matter what the marketing jokes say) If the problem is thin skin, there is little that can be done to thicken it. Vitamins A and C creams and light-weight treatments can provide some improvement over time. However, dark masking with concealer or mineral makeup is the most effective and cost effective.
Hyperpigmentation is a common cause and is extremely vulnerable to black people. It can be treated initially by topical creams containing retin A (exfoliating) and hydroquinone (bleaching) agents. My current favorite is TriLuma cream (available with prescription) as it contains Retin A, hydroinine, and steroids all in one. This should be used for several months before the expected upgrade. In very dark circles, the use of intense pulsating light (BBL, Broad Band Light) can also be tried but the power setting must be low and careful with eye protection. Medium-sized chemical peels (25% TCA) can also be tested but are also prone to hyperpigmentation. Eyelids should be treated before and after chemical peeling with a melanin suppressant to prevent this potential problem.
Hemosiderin staining, a byproduct of many blood vessels in the area, can also stain the skin of the eyelids. These causes can be difficult to determine. When available, it can be treated with topical creams containing Vitamin K or arnica or pulsating light treatments using 560nm or 590nm filters.
Set eyes or hollow eyes as the cause of dark circles require surgical removal. Bone on the lower edge of the eye less or flat causing the lower eyelid to indent. It attracts lower eyelids in, exaggerating the effects of natural shadows. The area under the eyelids must be constructed using either fat, orbital rim implants or fat transpositions. Subcutaneous fat closure is the simplest and most reliable method. By releasing fat from the bottom of the eye and bringing it out to the side of the bone rim, the lower eyelids are better supported and the depth of the cartilage is reduced. (as well as shadows) The implants are also mostly bones but the lower eyelid skin may make them feel or even look. Graft free fat is soft but not reliable for how much it will last after surgery.
Flow defects are a cause of dark circles that are not diagnosed. It is caused by an abnormal attachment of the lower eyelid to the bone causing the bottom of the eyelid to fall inside while the upper half is loose and full of fat coming out from under the eyes. As one ages, the lower eyelids appear to grow darker and darker. This current defect can be released through a transconjunctival approach (in the lower eyelid), which allows the fat to leap out of the dark circles. In some cases, fat grafts can be added as well.
As you can see, there are many causes of black circles and this is why there are so many topical treatment options ..... but none really work. Improvements in lower eyelid dark circles are possible but identify why they are important ... an internet product is not.
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