Dark Circles | Cause & Solutions

  / drdavinlim  
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What causes dark circles?
Dark circles can be caused by many factors. Most cases of dark under-eye circles have multiple causative factors including-

1. Lack of sleep, dehydration and/or high salt intake.
2. Genetic factors. More common in ethnic skin types.
3. Allergies such as hay-fever, conjunctivitis and sinusitis.
4. Dermatitis including allergic dermatitis, atopic dermatitis, irritant dermatitis and contact dermatitis.
5. Anatomical factors including prominent ocular bones combined with thin dermis and of lack of facial fat.
6. Age- as we age we loose collagen, HAs, fat and bone. Recession of the orbit occurs as we age, this is universally seen across all races.

How to treat dark circle/ DIY tips?
1. Treat the cause. Many causes, in some patients two or more factors give rise to dark under eye circles.
2. Elevate your head with pillows before you sleep. This reduces fluid pooling under your eyes.
3. Tea bags / cold compress. Though to be an old wife’s tale, tea bags have some merit. Cold compress can alleviate inflammation. Green tea is both anti-inflammatory as well as vasoconstricive.
4. Make up- never underestimate the power of make-up.
5. HA Sheet mask or eye masks- cheap method to increase hydration. Eye masks start at $3.00 USD. Hyaluronic acid can hydrate the epidermis and improve dark circles. Moisturise after mask application.
6. Retinol 0.5- 1.0. Obaji. Do not apply Retinoids if you have sensitive skin.
7. Look for topicals that contain Arbutin, Caffeine, Green Tea, Kojic acid, AHAs, Soy, Niacinamide, Ascorbic Acid, Hydroquinone 2%, and other pigment creams. Boron Nitride alter light transmission and can reduce the appearance of dark circles. Neostrata makes a cost-effective eye cream. TNS eye cream can be helpful in some patients. There is no magic eye cream- hence all major skin care lines will include ‘eye creams’ in their portfolio.
8. If you have allergies, antihistamines may work. This can decrease the itch scratch cycle and reduce rubbing of your eyes. Allergies can cause puffy, dark circles under your eyes. You may also experience redness or watery, itchy eyes. This reaction is caused by your immune system’s response to something that irritates it, or allergens.

How does a medical dermatologist approach dark under circles?
Dermatologist can exclude allergies with a detailed history. Medical dermatologist can conduct patch testing with a standard battery of tests. In some cases ROAT – repeated open application testing to determine if you are allergic to certain creams. More specific patch testing will investigate if you are allergic to fragrance, nickel, preservatives, SLS, propylene glycol, and other common chemicals found in creams or the environment. Allergist can conduct de-sensitization protocols for common allergens- house dust mite, animal dander, grasses, pollens etc…

How does a procedural dermatologist approach dark under eye circle?
If appropriate, refer to a medical allergist or dermatologist the exclude medical conditions. There are many methods to help with under eye dark circles including-

1. Dermal fillers. In this area I prefer Restylane or Belotero. Over the past 6 years I have used Juvederm Volbella. In my personal opinion, this filler can migrate, additionally cross linking (Vycross) can rarely give rise to filler reactions. I prefer a low density of HA to reduce both lumps and the Tyndall effect.

2. Fat transfer. This is an acceptable method to treat tear troughs and dark circles. The cons of fat include absorption and lumpiness.

3. Microdermabrasion can help, as can Hydrafacial.

4. Pico or nano lasers can be effective. 1064 or 755 nm lasers can decrease pigment but also increase collagen production. Picosure- Picoway will require 2-4 sessions, nano lasers 4-8 sessions. Less PIH with nano than picosecond lasers.

5. Fractional lasers can help. I prefer the 1927 Fraxel or 1927 Diode laser called Clear and Brilliant.

6. RF devices such as Pelleve can improve skin tone and decrease skin laxity. 3-5 sessions. Pelleve is a no downtime procedure compared to fractional laser resurfacing.

7. Chemical peels – AHA, lactic acid or 1-2% tretinoin peels can help. Caution if you have sensitive skin.

8. For anatomical causes of dark circles, surgical implants may improve structures that give rise to shadows.

The treatment of dark circles is extremely complex as there are many factors that come into consideration. In summary- treat the cause or causes. There is no magic eye cream.

One new video every week, cheers,
Dr Davin S. Lim
Laser and Procedural Dermatologist
Brisbane. Australia.