Dark circles under the eyes occur in all age groups and in people of all races. Dark circles under the eyes are also called tired eyes and the most common complaint I hear as a physician is that people who have dark circles under their eyes are told by family and friends that they ”look tired” when in fact they feel fine and totally rested. Dark circles under the eyes also create a facial appearance not only of fatigue but also of ill health. Correction is possible:

Contact Dr Seckel

There are many proposed “cures” for dark circles under the eyes from cucumber compresses to tea bags but in fact most of the home remedies for dark circles under the eyes simply do not work.

The reason most remedies for dark circles under the eyes do not work is that in most cases the dark circles under the eyes are caused by structural changes in the eyelid and the bony eye socket, and soaking the dark circles with tea bags or anything else simply has no effect on eyelid structure.

To understand how to correct dark circles under the eyes it is first important to understand what causes the dark circle. There are several different conditions which people call dark circles under the eyes but only one true anatomic dark circle under the eye exists. Various conditions that are referred to as dark circles under the eyes are:

1. Dark eyelid color, usually purple or bluish tone of the eyelid skin. This is a normal condition of all human lower eyelids and is not a true dark circle under the eye. The dark eyelid color is caused by the fact that the eyelid skin is so thin that we can see through the skin and the eyelid muscle beneath the lower eyelid skin is a purple color, and thus we are seeing the color of the eyelid muscle showing through the eyelid skin. This is not a dark circle under the eye but a normal dark eyelid color present on everyone. It is more noticeable in very fair and thin skinned people. The only remedy is cover up make up, the best are Jayne Iredale, Covermark, and Dermablend
2. Pigment and sun damage on the lower eyelid skin. Many people have brown pigment on the lower eyelid which they confuse with dark circles under the eyes. This brownish discoloration is caused by the sun, can be caused by pregnancy or by birth control pills. The condition is caused by pigment deposited in the skin of the lower eyelid and is not a true dark circle under the eye. This pigment can be removed by bleaching creams, Obagi Skin Care System, IPL or Photo facial, and some lasers.
3. Hollow eyes. Many people have hollow eyes or a sunken in eye appearance which is often confused with dark circles under the eyes. The hollow eye can create a dark circle appearance but the whole eyelid is sunken in and has a shadow cast over it by the brow. This does create a dark appearance of the lower eyelid but is distinct from the true dark circle under the eyes. Hollow eyes are caused by a deficiency of supporting fatty tissue beneath the eyeball, thus the eyeball “sinks in” to the bony eye socket and the lower eyelid sinks with the eyeball. This fatty deficiency can be inherited or can occur because of trauma to the bone of the eye socket. Correction requires reconstructive plastic surgery of the bone of the eye socket or grafting of fat into the eye socket to correct the deficiency.
4. Dark Circles Under the Eyes, the Tear Trough Deformity. The true dark circle under the eyes, technically called the naso-jugal fold or tear trough deformity is a dark line running beneath the lower eyelid, starting at the corner of the lower eyelid next to the nose and running out towards the side of the face towards the ear. The dark circle under the eye is actually a semicircle or crescent shape and is also referred to as the crescent deformity. The dark circle under the eye runs directly above the rim of the orbit, the bony socket of the eyeball and if you press ion the dark circle under the eye you can feel bone.

Several anatomic factors cause the dark circle under the eye. First, the eyelid skin of the dark circle is tightly connected to the bone of the eye socket by a structure called the arcus marginalis which is a condensation of the inner eyelid tissues which attaches to the bone and holds the skin of the dark circle under the eye tightly to the bone. Thus the skin of the dark circle is not free to move or sag with the rest of the lower eyelid skin. As we age, the rest of the eyelid skin becomes lax and falls down over the dark circle under the eye creating a shadow in the dark circle making the dark circle under the eye much more noticeable. In addition, many people have a slight bulging of the fat beneath the eyelid which pushes the lower eyelid skin outward above the dark circle creating a bulge above the dark circle and making the dark circle under the eye more noticeable. The bulging fat above the dark circle under the eye causes the condition called eye bags or puffy eyes. Allergies and excessive salt intake or other fluid retention can cause swelling of the eye bags and make the appearance of the eye bags and the dark circles under the eyes worse.

With advanced aging of the eyelids the dark circle under the eye can extend further out into the cheek and is called a tear trough deformity. This name is derived from the fact that when we cry the tears roll out to the side of the cheek rather than straight down the cheek as tears do in children.

Correction of true dark circles under the eyes requires surgical release of the arcus marginalis to release the dark circle from the bone. In addition, the lower eyelid fat is repositioned or grafted on to the bony rim of the eye socket to “plump up the dark circle” and prevent the reattachment of the dark circle to the bone. I prefer to do this procedure using a laser transconjunctival blepharoplasty incision on the inside pink portion of the lower eyelid. This technique avoids a visible external eyelid incision and preserves the beautiful natural shape of the eyelid.

There is a new experimental skin tightening methods using the Aluma skin tightening radiofrequency machine to tighten lower eyelid skin. Early results in younger people with little skin laxity and early eye bags are encouraging. If the skin laxity and puffiness can be improved then hopefully the shadow in the dark circles under the eyes will be lessened and the dark circles under the eyes will be less noticeable. However the problem of the attachment of the arcus marginalis is not corrected by non-surgical skin tightening.

Some physicians are attempting to correct dark circles under the eyes by injecting fillers such as restylane, radiesse, juvaderm, and others into the dark circle. While I am sure some physicians achieve good results with this technique there have been problems with visible lumps and swelling which can be very distressing. There also has been a reported case of blindness due to injury to the blood vessels feeding the eye, thus I do not recommend filler injections for correction of dark circles under the eyes.

In summary, it is important to understand the various conditions that are called dark circles under the eyes before you consider seeking treatment or a “cure”. Laser treatments for pigment will not correct the true dark circle under the eye. Dark eyelid color is a normal phenomenon for all of us. As of this date, to my knowledge, the only way to correct the true dark circle under the eye is to release the arcus marginalis and reposition or graft fat beneath the dark circle. My experience with tear trough implants, while helpful for severe deformities, has not been satisfactory for the majority of people I see with true dark circles under the eyes.

For further information or questions about dark circles under the eyes, contact me or read Save Your Face.

Dr. Seckel

Boston, Massachusetts

This entry was posted on Friday, April 6th, 2007 at 11:20 pm and is filed under Eyes. Both comments and pings are currently closed.