February 25th, 2016
There are a number of causes of under-eye circles or bags. These can be grouped into anatomic, lifestyle, or medical causes.
There are simple things you can do to alleviate dark circles under your eyes. Sometimes the problem is minor or temporary, in which case an inexpensive home treatment may be appropriate.
Before undergoing treatment, it is important to know the origin of the under eye circles. Treatment varies due to the condition causing the problem. In some cases, multiple factors are causing the dark circles, so a combination of treatments might be needed. Below is a list of common products/procedures we use in our office to combat dark circles.
Topical bleaching agents such as hydroquinone and Lytera are available for skin lightening. These products help to brighten the skin as well and treat hyperpigmentation, sun damage, and melasma. Other products include: TNS Essential Serum, TNS Recovery Complex, and TNS eye cream. Other ingredients that are known to help improve pigment include: Vitamins C and K, green tea, licorice, and kojic acid.
Lasers have a number of different applications to help improve several of the causes of dark under-eye circles. Reduction of dilated blood vessels and pigment can be accomplished with the Cutera Excel V 532 laser. This laser is a more advanced version of the IPL, but with a more concentration wavelength for pigmentation and better treatment for vascular lesions. Laser is appropriate when blood vessels are visible as dark purple or blue under eye circles. A second type of laser can be used to reduce dark circles by tightening the skin (improving fine lines and wrinkles), treating pigment problems, and improving over-all skin quality. These treatments are most effective when used with complimentary skin care treatments.
Injectable fillers containing hyaluronic acid are often used to correct dark circles created by tissue loss under the eyes and upper cheeks and thinning of under eye skin. Restylane is the most common recommended hyaluronic acid filler for restoring volume to the tear trough, but our recent experience has been with using Voluma (which has a much longer duration of +2 years) to restore cheek volume and use in the tear trough. In addition to improvement in the tear trough, improvement overall facial shape is seen (with reduction of the "parentheses" lines around the mouth and "smile lines" around the eyes).
Like fillers, a patient's own fat can be harvested (liposuction or fat grafting) from another body area and injected in the tear troughs to treat dark circles. Typically recommended for correction of dark circles caused by tissue loss of cheek and under eye or thinning skin under the eye, fat injections are a more permanent treatment option for loss in the under eyes or upper cheeks. Unlike hyaluronic acid fillers, fat injection results are permanent solutions to under-eye circles.
In one form or another, eyelid surgery (or blepharoplasty) is generally one of most effective ways to permanently get rid of dark circles. For patients with under-eye circles due to congenitally flat face, a silicone cheek implant may be recommended to augment the facial bones and eliminate the under-eye bags. This can be done in conjunction with fat grafts to smooth and soften the area under the eyes.