Dear Dr. Seckel, Despite what most people think, deep, dark circles under your eyes are not primarily caused by being tired or stressed. Instead, dermatologists and plastic surgeons agree that capillaries that leak blood close to the skin’s surface cause dark circles. When this blood begins to oxidize it turns a bluish red color, similar to an ugly bruise. And since the skin under the eyes is very thin, this leads to the appearance of those embarrassing bags and dark circles. The more transparent your skin and the more blood that pools under it, the darker the circles appear. And what’s worse, this discoloration over time can become permanent. The skin around the eyes is thin, and thus susceptible to dark circles. Surgery can not eliminated dark circles. I found this on a web site do you have any comments about it? I am also wondering if dark circles are due to broken capillaries how a blepharoplasty surgery can help with it? Thank you, Frank, London,UK
Dear Frank,
Thank you for your interesting question about dark circles under the eyes. There is great confusion among doctors and patients alike as to what is meant by the expression dark circles under the eyes and about what type of eyelid rejuvenation procedure is best to remove dark circles under the eyes. I agree with you that stress and fatigue have nothing to do with dark circles under the eyes.
I do not agree with the premise that surgery cannot correct the most common cause of dark circles under the eyes. In fact surgery with a transconjunctival laser blepharoplasty and an arcus marginalis release is the only effective treatment for most cases of dark circles under the eyes also called the tear trough deformity or crescent deformity.
The dark circdles under the eyes like condition you describe with capillary leakage and deposition of pigment can certainly cause a brownish red color in the skin of the lower eyelid, but this is a pathological condition, which follows injury and or trauma and is uncommonly permanent and is not what I consider dark circles under the eyes.
Under normal circumstances (that is after not suffering trauma or injury) blood does not leak out of the capillaries and become deposited in the eyelid skin-this does happen after a black eye caused by trauma or surgery (such as rhinoplasty-nose job). But in the majority of people the body’s normal defense mechanisms utilize macrophages-tiny scavenging white blood cells-that come into the eyelid and digest and remove the pigment. This condition, if caused by trauma wound be called an ecchymosis not dark circles under the eyes.
However, in the normal state what many people refer to as dark circles under the eyes are caused by the fact, as you point out, that the eyelid skin is so thin that we can see through the skin, and the purple color of the orbicularis occuli muscle shows through the skin and transmits the dark blue color of the eyelid or dark purple color of the eyelid. I call this normal condition dark purple eyelid color, not dark circles under the eyes. If the attachment of a structure called the arcus marginalis pulls the lower eyelid skin down to the bone and creates a depression, which appears on the eyelid skin as a dark circle beneath the eyelid, then I call this condition dark circles under the eyes.
Dark circles under the eyes is a distinct anatomical entity, technically called the tear trouigh deformity or crescent deformity which is more prominent in many groups. It is I believe familial or genetic and is based on the underlying bone structure of the orbit-the bony cavity supporting the eyeball, and the attachment of the arcus marginalis. Dark circles under the eyes is common and is more common in certain countries, in my experience in the UK, US, and in India. In many people only the arcus marginalis causes the dark circles under the eyes, however I have found that some people also have a bony deficiency which makes the dark circles under the eyes much worse and creates the hollow eyes look. This distinction is very important, as surgical correction of hollow eyes requires an implant as well as fat grafting.
Dark circles under the eyes are very distinct and different from purple eyelid color, which occurs in every human being. Dark eyelid color as I mentioned above is caused by the purple color of the eyelid muscle showing through the thin eyelid skin and is not related to the arcus marginalis which causes the dark circles under the eyes.
There are many other contributing factors to dark color and shadows beneath the lower eyelids-hollow eyes that cast a shadow, superficial veins and blood vessels near the surface, but in most people who have true dark circles under the eyes it is the crescent deformity or tear trough deformity caused by the attachment of the arcus marginalis ligament that causes the appearance. In all people the color of the eyelid skin on the lower eyelid is darker than the surrounding facial skin.
Many dermatologists and others promote the use of laser skin rejuvenation and laser peel procedures on the skin surface to correct dark circles under the eyes, and justify their recommendation by the mechanism you write about. These therapies don’t work because they cannot lighten the color of the eyelid muscle beneath the skin and can cause other problems. In some individuals who have brown pigment in the lower eyelid or numerous superficial blood vessels laser therapy on the eyelid skin can work, but I prefer and use IPL-Intense Pulsed Light-which I think is safer and more effective,
Thank you again for your important question. For more information on lasers, dark circles under the eyes, eyelid rejuvenation, and non-surgical facial rejuvenation read Save Your Face or contact me.
Boston, Massachusetts