Six Treatable Causes of Dark Circles Under the Eyes
Many of my patients ask what causes dark circles under their eyes. There is great confusion about the cause of most dark circles. In my experience most patients with dark circles under their eyes have had dark circles since childhood. Also, it is very common that dark circles occur in other family members, so inheritance is an important cause of dark circles in many people.
In my experience most dark eye circles are caused by one of six different causes. Happily, dark circles caused by all of these six factors can be improved or removed.
It is important to understand the cause of the dark circle because the cure depends on the cause. Let’s first review the most common six causes of dark circles under the eyes. Once we understand what causes dark circles, I will review the best treatments to remove the dark circles.
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. See before and after treatment of my patient below:
How to Treat or Remove Dark Circles under the Eyes
• Intense Pulsed Light-IPL-Photo Facial Treatment of Dark Circles- 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. IPL can help lighten dark eyelid skin caused by blood vessels or pigment.
• Fractional Ablative Laser Skin Resurfacing Treatment of dark Circles- Ablative 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. These treatments can remove pigment and wrinkles.
• Laser Transconjunctival Blepharoplasty with Arcus marginalis Release and Fat Grafting for Removal of Dark Circles- This is a plastic surgery operation that is done to remove dark circles caused by the arcus marginalis and in patients with 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. See before and after photos of my patients arcus marginalis release in the lower eyelid below:
• Fat Grafting for the Hollow Eye Dark Circle Syndrome- 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 Soft Tissue Filler Injections around Your Eyes to Treat dark Circles under the 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.
For more information on the causes and treatment of dark circles under your eyes call 978-369-4499 or email us. Read our free newsletter to keep up to date on new discoveries in aesthetics, non-surgical facial and eyelid rejuvenation and plastic surgery. Read Save Your Face to learn how to prevent facial aging.
Dr. Seckel
Concord, Massachusetts
Boston Massachusetts