What do I do about dark circles under the eyes? Options for treatment.

What do I do about dark circles under the eyes? Options for treatment.

Dark circles under the eyes are secondary to shadowing and skin color changes in this area. The shadowing is caused by a natural groove in this area called the tear trough.

  • The tear trough is created by the deep attachment of the skin and muscle to the underlying bone. It functions to segment the movement of the lower eye muscle, but can worsen with age when the cheek fat descends or the septum holding lower eyelid fat in weakens.
  • The skin in this area is as well thin and can have inherent dark pigment or show the dark color muscle underneath.

The majority of the lower eyelid darkening is secondary to the tear trough and/or the naso-jugal groove. This can be corrected with skin hydration with an eye cream which helps moisturize and smooth the lower eyelid skin.

A hydrating moisturizer can be applied to the lower eye in the morning and in the evening as part of the eye care treatment for dark circles.

  • The Skinmedica® TNS™ Eye Repair cream based products are easily applied and easily tolerated in this area. This is a growth factor based product which can help stimulate collagen and eliminate fine lines.
  • The A.G.E Eye Complex from SkinCeuticals® is a daily optical diffuser to help deflect shadowing, while improving the skin’s texture through hydration and potent anti-oxidants.

Volumetric fillers such as hyaluronic acid gels like Restylane®Juvederm® or Voluma® can help to fill a deep groove and level the skin in this area. This may be the first step in treating the dark circles under the eye and is usually indicated in the young woman who has had darkening throughout her life but has worsened in the late twenties or thirties. It is an in-office procedure with minimal recovery. The most frequent complication is bruising and incomplete correction. It usually requires two treatments for a complete correction of the tear trough and may require one to two syringes of filler per eye. Aftercare involves icing for two days and bruising can be covered with makeup. The downside is that fillers are not permanent and the area requires more volume than you would expect to achieve a noticeable result. Fillers in this area can last over one year and usually require half of the volume on reinjection of the areas. Sculptra® may be used in this area to help stimulate collagen growth and smooth lines in this area. This would be a gradual but more permanent solution to an office based treatment for dark under eye circles and is utilized primarily in the cheek area.

Fillers should be combined with skin care to maximize the treatment of the dark eye circles. Chemical peels can be applied to the lower eyelid skin to help tighten the skin and eliminate fine lines. A gentle chemical peel of the lower eyelids can be performed at the same time as a filler. The peel type may be a glycolic acid peel or 10% TCA peel. These can be repeated to optimize the results over a 6 week period.

Surgical options for dark circles and associated a deep tear trough, include lower eyelid blepharoplasty with fat repositioning and ligament release to fill and tightening the lower eyelid. This requires a general anesthesia and a longer recovery, though the results are long lasting and likely more affordable in the long run as compared to repetitive filler treatment. It is not uncommon to perform lower eyelid blepharoplasty on the young patient for this problem. Male and female plastic surgery patients in their thirties may consider this option for the permanent treatment of lower eyelid dark circles.
A consultation with Dr. Trussler in Austin, TX would be the first step to help formulate a treatment plan for lower eyelid dark circles.

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Posted in: Blepharoplasty, Injectable Fillers, Juvederm

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Andrew Trussler, MD
5656 Bee Cave Road – Suite J200
Austin, TX 78746
Phone: (512) 450-1077 | Fax: (512) 450-1817

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