Many people come to my plastic surgery practice wanting treatment for removal of dark circles under the eyes. Most often they tell me they look tired and that people often ask them if they have gotten enough sleep. In my experience lack of sleep, watching too much TV or spending a lot of time on the computer has nothing to do with dark circles under the eyes.
There are specific medical or structural eyelid causes of dark circles under the eyes that many physicians just do not understand. There are very effective modern laser and light treatments that can permanently remove the dark circles under your eyes.
However, treatment must be directed at the underlying medical cause of the dark circles for removal to be effective. Therefore I am going to discuss the medical and structural causes of dark circles under the eyes first. Once you understand the cause, you will be able to seek the right treatment for removal of your dark eye circles.
Medical Causes of Dark Circles under Eyes
• 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 which appear as dark circles under eyes.
• 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. Broken blood vessels are a common cause of dark circles under the eyes.
• 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. Dark pigmentation such as this is a very common cause of dark circles under the eyes.
• 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. Hollow eyes can cause very pronounced dark circles under the eyes.
• 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 called 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. I view the arcus deformity as the true dark circle under the eye.
• Bags under Eyes, Puffy Eyes and Eyelid Aging- 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 circles under the eyes I see in my plastic surgery practice. See before and after treatment of my patient below:
Dark Eye Circles Treatment–How to Remove Dark Circles under the Eyes
• Intense Pulsed Light-IPL -Photo Facial Treatment For Removal of Dark Eye 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.IPLcan help lighten dark eyelid skin caused by blood vessels or pigment and remove dark circles under the eyes.
• Fractional Laser Skin Resurfacing Treatment of Dark Circles- Ablative Fractional 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 and remove dark circles under the eyes.
• Transconjunctival Laser 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. This is the most effective laser method for removal of dark circles under the eyes. See before and after photos of my patient’s 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. The fat grafting technique is the most important component for removal of dark circles under the eyes.
Words of Warning and Advice About Dark circles under Eyes
• Do Not Have Soft Tissue Filler Injections Near 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 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 Plastic Surgeon- 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. Good resources for reliable information are:
American Board of Plastic Surgery
American Society of Plastic Surgeons
American Society of Aesthetic Plastic Surgery
For more information on the medical causes and laser and surgical treatment of dark circles under your eyes call 978-369-4499.