What to Do With Those Dark Circles Under Your Eyes

The development of dark circles under one’s eyes makes you look tired. Some people develop dark circles with aging, while others have had them from when they were young. Dark circles occur just as frequently in Caucasians as they do in more darkly pigmented people. Dark circles, contrary to popular thought, is not due to being tired, stressed, or worn out. (no matter how you feel!) Dark circles develop due to staining of the thin eyelid skin from pigments that have leaked out from your blood cells. The blood cell pigment, known as hemoglobin, oxidizes when it gets close to the skin’s surface due to light exposure and turns a bluish red color. (the hemoglobin turns to hemosiderin, an iron-based pigment) This discoloration subsequently looks like a bruise and is easily seen since the lower eyelid skin is very thin and almost transparent. Once the dark circles appear from the pigment deposits, they may likely be permanent.

What can one do for dark circles? First and foremost, eyelid surgery will not get rid of dark circles. Lower blepharoplasty, which removes excess lower eyelid skin and fat, does not directly target the pigment-staining problem. In the short-term, it may actually make it look worse due to the bruising from surgery and has the potential to place more blood products near the skin to be broken down. In some cases, there is some improvement in the appearance of the dark circles as the lower eyelid is tightened and there is less of an undereye hollow for shadowing to appear in. But one should never undergo lower blepharoplasty if your main objective is to get rid of the dark circles. Any improvement in the dark circles should be considered a bonus but not the main objective of the surgery.

Secondly, peeling, burning, or exfoliation of the lower eyelid skin does not usually work well either. Whether it is done by a chemical peel or laser resurfacing, the removal of the outer layer of the lower eyelid skin does not reach the area where the pigment deposition lies. Resurfacing removes the outer epithelium of the skin but does not, or should not, reach the deeper dermis or the underside of the skin. (if it does, the lower eyelid will scar) While I don’t think there is much harm to a lower eyelid peel, with a 25% or 35% TCA solution, it is not particularly effective in most cases. And runs the risk of an additive problem known as hyperpigmentation which can contribute to the darkness of the lower eyelid skin.

Potential leaching of the skin through hydroquinone topical preparations seems like a reasonably safe approach, although how it works doesn’t necessarily specifically target the pigment issue. Hydroquinone works by suppressing the melanin or color production of the skin so it is easy to see how this may be effective for hyperpigmentation or age-related (sun exposure) brown spots. But this bleaching chemical is not known to specifically break down and clear hemosiderin pigments stains. So bleaching the skin sounds like it would work, but the chemistry behind it would suggest otherwise.

Lastly, many topical skin creams claim dark circle improvement and some are even labeled as dark circle repair serums. These contain agents such as arnica, haloxyl, and other enzymes that purportedly break down the pigments and help the dark circles fade. While theoretically appealing, there is very little good clinical or study information that would support these claims. Even if effective, it would be a slow process in which it would takes months to begin to see improvement. (which is OK if improvement actually occurs)

My frustration with dark circles has led me to try another approach. I currently am using light therapy (intense pulsed light, specifically broad band light) with vascular filters in combination with topical dark circle serums. It strikes me that something is needed to initiate the pigment break-up and light therapy can specifically target that without injuring the overlying skin. And without any recovery for the patient. I currently am doing a series of 3 light treatments spaced one month apart with nightly applications of the topical serum. It is too early to tell if this is a magical approach but some patients are already experiencing improvement in the first month.