Millions of people have dark circles under their eyes. The causes of this condition vary, and there is great confusion about what actually causes dark eyelid skin and depressions, called circles, beneath the lower eyelid. Exciting, effective, new laser and light treatments are available. However, before I talk about how to correct the problem I want to make sure you understand what causes dark circles under your eyes. The cause will determine which laser or light treatment is best for you.
Causes of Dark Circles
• Thin Eyelid Skin- Eyelid skin is so thin that you actually see through the skin and see the color of the eyelid muscle, which is purple. Look at every face you see and you will see that the lower eyelid is the darkest colored skin on the face. People with very thin skin have darker lower eyelids.
• Visible Small Blood Vessels- Many people have hundreds of small blue veins visible on the lower eyelid. These blood vessels cast a blue dark appearance to the lower eyelid.
• Pigment-People who have excess sun exposure and do not wear sun block often develop brown pigment on the lower eyelid. People of dark skin types such as African American, Hispanic, Asian, Arab, and Central Asian people are very susceptible to pigmentation of the lower eyelid.
• Hollow Eye-Many people have a hollow eye appearance. This is caused by a lack of fat surrounding the eyeball. The hollow eye is most often inherited, and is very common in people of Central Asian origin, in my experience.
• Arcus Marginalis Deformity- Many people have a deep depression beneath the lower eyelid which they have noticed since childhood. It is an anatomic or structural condition which is usually inherited. It is caused by a small structure caused the arcus marginalis which tethers the lower eyelid skin to the bone of the eye socket. The skin of the eyelid above the arcus falls over and downward creating a deep shadow which is referred to as a dark circle under the eye.
• The Aging or Puffy Eye or Eyelid Bag- As we age our skin loses elasticity and becomes lax. As the lower eyelid becomes lax it fails to support normal fat which lies below the eyeball. This fat pushes the lower eyelid forward and forms a puffy eye or eye bag. The eye bag or puffy eye creates a dark shadow beneath the bulge where the arcus marginalis is tethering the skin to the underlying bone. This is the most common form of dark circle under the eye I see in my plastic surgery practice.
Laser and Light Based Treatments to Correct Dark Circles under the Eyes
• Intense Pulsed Light-IPL-Photo Facial- These therapies are not lasers. They use a flash of light which specifically targets the color of a pigment or blood vessel in the skin. The light is adjusted to be absorbed by the color red or brown. When the light energy is absorbed by the colored target, the target is heated and destroyed. IPL is set for red to close blood vessels, and brown to remove pigment. IPL can correct dark eyelid skin that is caused by visible small blood vessels and pigment. IPL on the eyelids should be done by a doctor. Eye shields must be placed over the eyeball to protect the eye. No anesthesia is required, you just feel a small snap as the light hits your skin. Usually three treatments scheduled 5 weeks apart are required for the best results.
• Fractional Ablative and Non-ablative Laser Resurfacing- Laser resurfacing can remove wrinkles and stimulate new collagen production in the skin. In some cases fractional laser resurfacing can be used to plump or thicken thin eyelid skin. Non-ablative laser resurfacing causes temporary pink skin but no skin removal or recovery is required. Non-ablative fractional laser resurfacing requires four treatments scheduled six weeks apart. Ablative fractional resurfacing requires topical local anesthesia, the skin is broken and 5-7 days of redness during recovery. Ablative fractional laser resurfacing is usually only done one time.
• Laser Transconjunctival Blepharoplasty with Arcus marginalis Release and Fat Grafting- This is a plastic surgery operation that is done to remove puffy eyes or eye bags. A laser beam is used to make a small incision on the inside pink part of the lower eyelid called the conjunctiva. The arcus marginalis which is tethering the lower eyelid skin and causing the dark circle is released, and the removed fat is then placed back inside beneath the arcus marginalis to plump the depression which was causing the dark circle. Some surgeons perform this procedure through an external lower eyelid incision, but I do not because the external incision weakens the support of the lower eyelid. This can cause a change in the shape of the eyelid to a sad eyed look. The internal incision, the transconjunctival incision does not change the beautiful shape of the eyelid. This technique is used to correct The Aging or Puffy Eye or Eyelid Bag and also used to correct the Arcus Marginalis Deformity in younger people. See before and after arcus release and fat repositioning with laser transconjunctival blepharoplasty of the lower eyelids only in my patient below:
• Fat Grafting for the Hollow Eye- For people who have a hollow eye appearance because they lack enough fat around the eyeball, I harvest fat from around the umbilicus or belly button. I then make a laser transconjunctival incision inside the lower eyelid and place the fat in a position to plump the hollow appearance.
Words of Warning and Advice
• Do Not Have Injections around Your Eyes- Many doctors are injecting soft tissue fillers to plump depressions beneath the eyelid. This is an off label use which means the companies that make the fillers do not recommend it. There has been a reported case of blindness in England caused by injecting a soft tissue filler around the eye.
• Do Not Have Fat Injections to Correct Dark Circles under the Eyes-Fat injection is a blind procedure in which your own fat is injected beneath the eyelid skin. The eye can be injured and frequently the fat is placed in the wrong position and the depression beneath the eyelid looks worse. I have had to surgically remove fat placed by other physicians. Some, very few, surgeons can do it well, but I will not risk the potential complications.
• Choose an Experienced Board Certified Doctor- Eyelid surgery and laser surgery are very sophisticated fields which require training, board certification, and most important-experience, in my opinion. Always seek two opinions and do your homework on the doctor you choose.
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