What are true under-eye circles?
Dark circles under the eyes, which have several potential underlying causes. The treatment should target the causative factor(s). With true dark circles, pigment or darkness will be seen in the eyelid skin. Pseudo-dark circles caused by shadowing beneath fatty eyelid pouches and eyelid hollowing are treated with lower eyelid lift or fillers.
What are the treatments for true dark circles under the eyes?
Topical agents
A sunscreen with an SPF of at least 30 is crucial in preventing further UV damage and dark discoloration.
Topical creams with antioxidants can aid in reducing inflammation and reversal of sun damage. Topically applied Vitamin C (in the form of L-ascorbic acid) is a potent antioxidant that is effective in sun damage protection and repair. It may improve dark under-eye circles caused by inflammation.
Significant inflammation (and post-inflammatory hyperpigmentation) can benefit from topical steroids. This medication is usually prescribed for a limited period of time based on specific conditions.
A topical retinol (tretinoin) is a form of vitamin A that also reverses sun damage, restores the thickness of thinned skin, and improves skin cell turnover.
Anti-pigmentation creams reduce the amount of melanin in the skin. Hydroquinone is an effective anti-pigment or “bleaching” agent. When used in combination with an exfoliant it is more effective. Results can take months to appreciate in accordance with the natural skin turnover cycle.
Concealers are simple and effective for the camouflage of under eye dark areas. Powdered minerals tend to be less irritating than thicker creams.
Laser and light treatments
Intense pulsed light (IPL) is a broad-spectrum light treatment that targets red and brown problem areas on the skin. The light-based energy is absorbed by specific colors in the skin (red from blood vessels, brown from melanin) and is converted to heat. The heat selectively injures the target area. Multiple treatments may be required.
Erbium and carbon dioxide (CO2) resurfacing lasers create non-selective injuries in the skin. These lasers are often delivered in a fractional manner (small injuries with interspersed normal, untouched skin). They help to reduce wrinkles, sun damage, and brown spots. Under the eyes, they can help to reduce dark circles.
All laser and light treatments around the eyes must be performed by experienced practitioners that are trained in eye protection and have an understanding of the behavior of delicate eyelid skin.
