Dark circles under the eyes are an increase in relative darkness of the Emperor orbital skin relative to the cheek skin below. In dark skinned Caucasians, Asians, Blacks, this problem can start early in life. It also can occur in lighter skin Caucasians. Young children with allergies are often known to have “allergic shiners”.
There are 3 major causes of the dark circles. Excessive pigmentation of the skin is the most common, followed by hollowing under the eyes or protuberant fat pads creating shadows that appear as dark circles. In very light skin Caucasians with their thin translucent lower eyelid skin, the blood vessels under the skin and in the muscle appear dark and purpleish. This is the so-called “allergic shiners” in children, but also can occur in all ages.
There are some congenital and hereditary conditions that lend to the increased pigmentation, but the most common is pigmentation caused by inflammation such as allergy + the constant rubbing of the lower eyelids or pigmentation due to the aging process.
It is important to know the cause of the dark circles under the eyes because the treatment can be very different depending on the cause. Hollowing under the eyes causing dark circles is corrected with injectable fillers most commonly Juvederm Ultra Plus with Lidocaine. The sunken appearance lessens and the dark circles improve. If the lower eyelid have bags causing shadows under the bags then the bags have to be surgically removed either through an incision behind the lower eyelid or under the lash line. Dr. Ellis will be able to answer all your questions in the treatment of these types of dark circles.
Increased pigmentation in the skin needs to be treated with a combination of topical cream applications such as Teamine cream or Dermamalan cream. At the same time multiple treatments with laser Genesis is performed to help improve the pigmentation. Pigmentation under the eyes in darker skin people is difficult to completely eradicate but significant improvement can be seen.
Those patients in which have very translucent skin and are adults can be treated with topical creams to build up collagen in the skin along with some injectable fillers to thicken the skin. Occasionally fat transfer under the thin eyelid skin can offer some thickness to camouflage and improve the dark circles.