What to do about those dark circles under the eyes

The development of dark circles under the eyes makes you look tired. Some people develop dark circles with age, while others have had them since they were young. Dark circles appear just as often in Caucasians as they do in darker-pigmented people. Contrary to popular belief, dark circles are not due to fatigue, stress or wear. (No matter how you feel!) Dark circles develop due to staining of the thin skin of the eyelid due to pigments that have leaked from the blood cells. The pigment in blood cells, known as hemoglobin, oxidizes when it approaches the surface of the skin due to exposure to light, turning a bluish-red color. (Hemoglobin converts to hemosiderin, an iron-based pigment) Later, this discoloration looks like a bruise and is easily seen as the lower eyelid skin is very thin and almost transparent. Once dark circles from pigment deposits appear, they are likely to be permanent.

What can be done for dark circles? First of all, eyelid surgery will not remove dark circles. Lower blepharoplasty, which removes excess skin and fat from the lower eyelid, does not directly address the problem of pigment spots. In the short term, it can actually make you look worse due to bruising from surgery and has the potential to put more blood products close to the skin to break down. In some cases, there is some improvement in the appearance of dark circles as the lower lid is tightened and there is less gap under the eye for shadows to appear. But one should never undergo lower blepharoplasty if getting rid of dark circles is your main goal. Any improvement in dark circles should be considered a bonus, but not the main goal of the surgery.

Second, peeling, burning, or exfoliation of the lower eyelid skin usually doesn’t work well either. Whether done through a chemical peel or laser resurfacing, the removal of the outer layer of lower eyelid skin does not reach the area where the pigment deposit is located. Rejuvenation removes the outer epithelium of the skin but does not, or should not, reach the deeper dermis or underside of the skin. (if you do, the lower lid will leave a scar) While I don’t think the lower lid peel does much harm, with a 25% or 35% TCA solution, it’s not particularly effective in most cases. And you risk an additive problem known as hyperpigmentation that can contribute to darkening of the lower eyelid skin.

Possible skin leaching through topical hydroquinone preparations seems like a reasonably safe approach, although the way it works doesn’t necessarily target the pigmentation problem specifically. Hydroquinone works by suppressing melanin, or skin color production, so it’s easy to see how this can be effective for hyperpigmentation or age-related brown spots (sun exposure). But this bleaching chemical is not known to specifically break down and remove haemosiderin pigment stains. So skin whitening sounds like it would work, but the chemistry behind it suggests otherwise.

Lastly, many topical skin creams claim to improve dark circles and some are even labeled as dark circle repair serums. These contain agents like arnica, haloxyl, and other enzymes that are supposed to break down pigments and help dark circles fade. While theoretically attractive, there is very little good clinical or study data to support these claims. Even if it were effective, it would be a slow process that would take months to start seeing improvements. (which is fine if an improvement actually occurs)

My frustration with dark circles has led me to try another approach. I am currently using light therapy (intense pulsed light, specifically broadband light) with vascular filters in combination with topical serums for dark circles. It seems to me that something is needed to initiate the breakdown of the pigment and light therapy can specifically target that without damaging the overlying skin. And without any recovery for the patient. I am currently doing a series of 3 light treatments a month apart with nightly applications of the topical serum. It’s too early to tell if this is a magical approach, but some patients are already seeing improvement in the first month.

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