Dark eye circles or periorbital hyperpigmentation is complex as there are many causes. These include tear troughs / volume loss as well as pigmentation from excess melanin, or blood vessels. Address the causes & improvements can be seen.
- Dark circles can make the eyes look tired & aged
- Most patients will have at least two associated causes of dark circles
- Some cases are inherited, others due to excess pigmentation or volume loss
- Lasers, topicals, & dermal fillers are all possible solutions to reduce dark circles
- Most cases require combination treatments for best outcomes
Dark Circles Treatment at a glance
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Laser toning using pico laser & non-ablative fractional lasers can treat some cases of dark circles.
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Laser resurfacing reduces skin laxity causes of dark circles.
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There are many conditions that contribute to the colloquial name of dark circles. These include-
Anatomy: This overlaps with genetics, as a deep tear trough can give rise to dark circles. Age related volume loss makes it worse.
Vascular: Thin skin can result in prominent blood vessels. Treatments are aimed at modulating blood flow.
Genetic: Dark circles are almost universally seen in darker skin types. Pigmentation demarcation lines overlaps with constitutional pigmentation.
Post inflammatory: Allergies and rashes can increase pigment.
The ideal treatment depends on the cause, these include-
- Dermal fillers: are useful for volume loss and tear trough treatments
- Lasers: are great if there is associated skin laxity
- Tixel: is good for mild laxity
- Surgery: is indicated for severe laxity
- Anti-Inflammatory medications: are best for atopic dermatitis, irritant or contact causes
- Eye creams: can marginally help some cases caused by pigment or vessels
Dermal fillers can hide shadows from deep tear troughs. Fillers do not alter pigmentation, nor vasculature (with some exceptions). Support to the lower lid & medial cheek can also reduce shadowing from volume loss.
Hyaluronic acid fillers are great for the tear trough area, however if you have thin skin (or have had HA fillers & Tindall), collagen stimulating fillers are preferable.
Learn more (link to tear trough fillers in the dermal filler section)
Lasers can work via two mechanisms.
- Tightening skin through remodelling of collagen. This is achieved with fractional ablative lasers like CO2 & erbium. One to two sessions are required.
- Decreasing pigmentation of the lower and upper eyelid. Pico lasers do a good job. 2-4 sessions are recommended for best outcomes.
Learn more (link to Pico laser in the laser section)
Book a free* assessment with our nurses at Cutis. They can examine your dark circles & provide you with a safe, effective & tailored treatment plan. *T&C apply.
In some cases, yes. We employ deeper peeling agents for this task. The three main peels are-
- Jessner (Salicylic, lactic acid, resorcinol) TCA
- Phenol peels
Recovery following deep peels ranges from 6 to 16 days.
Surgery is indicated if there is significant laxity of the eyelids, or if there is significant fat prolapse. Partial removal of the eye bags can give a good result.
Effective treatment of dark circles follows a complex algorithm that may involve lasers, creams, dermal fillers, chemical peels & other methods to stimulate collagen & or reduce skin pigmentation. The method of choice depends on the cause.
Devices such as Thermage, RF Pelleve, Tempsure & others can help improve laxity. These devices work better in darker skin types as collagen contraction is brisker.
Heating skin can tighten & contract collagen, thereby reducing shadows around the eyes. 2-4 sessions depending on age, ethnicity, & clinical presentation.
No. Microneedling is not a good solution for eyelid skin. Trauma & blood can lead to post inflammatory hyperpigmentation, often worsening pigmentation. Better, safer & cheaper options include Tixel.
*Note: We do microneedle daily, but not around the eye area. Microneedling is best for delivering skin actives into the deep layers.
Tixel is a form of skin resurfacing using controlled heating. Tixel can improve dark circles associated with skin laxity. Tixel can treat the upper and lower eyelids, with downtime ranging from 1-4+ days. It is best suited for mild to moderate laxity.
Creams can treat vascular & pigmentation causes of dark circles. The results are marginal at best. Look for the following ingredients.
- Hyaluronic acid; acts as a moisturiser & humectant. Good for dry-sensitive skin
- Retinol; can increase collagen & may marginally improve some cases of vascular-thin skin.
- Alpha hydroxy acids, such as glycolic, lactic, and citric acids; can speed up exfoliation of dead skin cells.
- Botanicals such as green tea, bearberry, liquorice are antioxidants as well as pigment inhibitors.
- Caffeine, vitamin K are well-known modulators of blood flow. It can help some cases of dark circles due to vascular causes.
- Peptides; these are frequently added to more expensive creams. In theory may increase collagen production, in practice, questionable
- Argan oil; acts as an agent to reduce pigmentation, tyrosinase inhibitor
- Niacinamide or vitamin B3; acts as an anti-inflammatory agent. One of the safer skin care actives on the market
Tocopherol is an antioxidant; generally banal as an eye cream
Dark circles can be secondary to inflammation, a term known as PIH or post inflammatory hyperpigmentation. This can be due to –
- Atopic eczema, allergic conjunctivitis
- Allergic contact dermatitis
- Irritant contact dermatitis
Medical patch testing may be indicated in some cases to exclude allergies. If you have symptoms such as itch or irritation and eyelid concerns, your first port of call is a medical dermatologist.
Growth factor injections is great for hair loss but adds very little to improving dark circles. In most cases it worsens dark circles because it increases the incidence of bleeding. For more reproducible results, consider soft tissue fillers.
Genetic causes of dark circles are difficult to treat. This group includes-
- Pigmentary demarcation lines or PDLs. These present as an area of pigmentation 1.5-2 cm below the orbital rim. This form of pigmentation starts around adolescence and is more common in darker skin.
- Constitutional pigmentation is seen in ethic skin types. This form of pigmentation affects the areas of the lower & upper eyelids, forming a continuous C shape border. This pigment is one to two shades darker than facial skin.
- Some forms of deep dermal pigmentation. Hori nevus is treatable, but other forms of dermal pigmentation are harder to shift.
Undergoing pigment treatment is an investment for patients. Here are some helpful points that may help you along your journey.
- Does your provider understand the diagnosis? It is important to find the cause of dark circles, and not sell you a treatment or product.
- Sun protection is paramount. Sun protection is important. SPF 50+ twice a day regardless of exposure. If a 50 ml bottle lasts longer than 3 weeks, you are not using enough sunscreen.
- Medical over procedure, if you have itchy eyes. Treating the cause will improve your chances of successfully treating dark circles.
- More than one treatment session is needed. The only exception is volume replacement with fillers.
- Darker skin type: you may require more sessions compared to lighter skin.
- Settings of laser matter. Lasers are just tools to get the job done. Laser parameters are crucial for best outcomes. Additionally, using the correct vascular laser brand is vital for good outcomes.
- Don’t make it worse. Avoid microneedling, Growth factor injections & plasma pen. Side effects take a long time to treat. Do it right the first time around.