Dark Circles refer to conditions that present with relative darkness of the under eyes eyelids. This condition affects individuals of a wide range of ages, both sexes, and all races. It can be a significant cosmetic problem, and many individuals seek treatment for this condition. Having under-eyes dark circles makes you look tired, sad, or hungover. General fatigue, especially lack of sleep, worsens dark circles under the eyes. Dark circles also worsen with the aging process of skin sagging and altered subcutaneous fat distribution. The therapeutic modalities must differ depending on the cause because under-eyes dark circles are due to multiple factors. Physician Skincare products ( Dr. Derm cosmeceuticals), chemical peels, lasers, light sources, fat and filler injections, botox injections, and eyelids surgery are used to address skin darkening around the eyes.

Dark circles refer to conditions that present relative darkness of the under-eyelids. This condition affects individuals of a wide range of ages, both sexes, and all races. General fatigue, especially lack of sleep, worsens dark circles under the eyes. Having under-eyes dark circles makes you look tired, sad, or hungover. Moreover, it worsens with the aging process of skin sagging and altered subcutaneous fat distribution. It can be a significant cosmetic problem, and many individuals seek treatment for this condition.

What are the Causes of Dark Circles?

Under eyes, dark skin is seen skin conditions such as atopic or allergic contact dermatitis or nevus of Ota. The dark skin looks darker when they are present below bulging lower eyelids induced by pseudo-herniation of orbital fat. Bulging lower eyelids add a shadow effect and worsen the appearance. When the lower eyelid skin is manually stretched, the dark skin area spreads out without any blanching or significant lightening of the dark skin.

Another common cause of infraorbital dark circles can be thin, translucent lower eyelid skin overlying the orbicularis oculi muscle. The darkness may be due to the visible prominence of the blood vessels under the skin with the muscle. This condition usually involves the entire lower eyelids, with a violaceous appearance. This violaceous color is usually accentuated during menstruation.

Another cause of infraorbital dark circles is shadowing due to skin laxity (dermatochalasis) and tear trough associated with aging. A combination of the hollowness and the overlying pseudo-herniation of the under-eyes fat accentuates the tear trough’s shadow depending on the lighting.

What are Treatment Options for Dark Circles?

Several therapies are available for treating under-eyes dark circles. The therapeutic modalities must differ depending on the cause because under-eyes dark circles are due to multiple factors.

Dark-skinned patients with pigmented lesions are encouraged to use a combination of bleaching agents and exfoliants as part of their daily program up to 6 weeks before undergoing laser surgery and as soon as skin healing begins the following laser. Such an approach will block the creation of new pigments that feeds existing dark skin or prevent or lessen the development of new dark skin. Sun protection is, of course, mandatory all the time

Hydroquinone is the most prescribed bleaching agent worldwide and is still the criterion standard for treating dark skin. Topical retinoic acid (RA), 0.01% to 1%, reduces dark. You must apply RA for longer than hydroquinone, and significant lightening becomes apparent after 24 weeks. Other compounds used as depigmenting agents include azelaic acid, steroids, and kojic acid. Still, different joint preparations have been used to increase efficacy and reduce the side effects in the treatment of various dark skin disorders. In general, you must continue treatment with depigmenting agents for several months before cosmetic benefits are obtained.

Superficial peeling with trichloroacetic acid is still widely used in concentrations of 15%, 25%, and 50% in dark circles treatment. Alpha-hydroxy acids are a group of organic acids widely found in fruits and vegetables. Glycolic acid is the most widely used alpha-hydroxy acid. Glycolic acid produces epidermolysis at 50% to 80% concentrations, so physicians should perform the peel only as an office procedure. Glycolic acid should be applied for a few minutes, followed at once by rinsing with plain water or 1% sodium bicarbonate.

Dark circles due to excessive dark skin have been successfully treated with various pigment lasers, including the Q-switched ruby (694-nm) laser, Q-switched alexandrite (755-nm) laser, and neodymium-doped yttrium aluminum garnet (Nd: YAG) (1,064-nm) laser. The 1,064-nm Nd: YAG laser effectively reduces the dark skin and the vascular component of under-eye dark circles. It can clear dark circles with selective pigment laser or a resurfacing technique using the CO2 laser or both. Recently, a low fluence, Q-switched Nd YAG laser reported success in treating under-eyes dark circles due to dark skin.

Treatment of facial reticular veins is treatment with dynamically cooled, variable spot-sized 1064 nm Nd: YAG laser.

Skin laxity and tear trough are treated with ablative and nonablative lasers and surgery. These 1,064-nm Nd: YAG laser,1,320-nm Nd: YAG laser, 1,540-nm erbium: glass laser, and intense pulsed light sources.

It significantly improved skin laxity and periorbital wrinkles after an ablative CO2 laser. Nonablative laser systems are an ideal treatment choice for patients who are unwilling or unable to undergo prolonged postoperative recovery. The fractional CO2 laser may also help improve under-eye dark circles due to skin laxity and dark skin.

Those patients who complain of fine wrinkles and darkening of lower eyelid skin can be treated with 2U of botulinum toxin type A in the mid-pupillary line 3mm below the ciliary margin. It was also noted to increase the palpebral aperture. Although effective in diminishing the hyperkinetic lines, it is not recommended to treat the static wrinkles caused by photodamage or other causes, such as skin laxity. In these cases, I would recommend combination therapy.

The hyaluronic acid gel has been used successfully as a filler for the three-dimensional reshaping of the periorbital complex. The drawbacks of dermal filler in treating dark circles are the thinness of the skin of the eyelid and cheek–eyelid junction. If a soft-tissue filler is injected too superficially in these areas, there is a high risk of resulting in visible or palpable nodules. On the other hand, a deeper injection of the filler would not cover the visible blood vessels. Therefore, autologous fat would be the most suitable filler for treating under-eyes dark circles due to thin skin and apparent blood vessels.

The under-eyes area is a non-mobile area, which resulted in excellent survival of the transplanted fat. As under-eyes dark circles are due to thin and translucent lower eyelid skin overlying the orbicularis oculi muscle in our cases, transplanted fat allows the covering of the vascular areas and reduces the transparency of the skin. In a novel approach, Prof. Moawad starts using micro and nano fat with excellent results in dark circles due to the thin skin of the lower eyelids.

Lower blepharoplasty can be performed trans-cutaneous or trans-conjunctiva to correct pseudo-herniation and skin laxity of the under-eye’s region. Treatment of under-eye dark circles related to tear troughs is more complicated. It may require invasive surgical procedures to elevate the soft tissues from the underlying maxilla, fat transplantation or fat extrusion, and septal resection.

1. Under-eye dark circles are an unsurprising source of aesthetic concern of patients owing to the tired and less youthful appearance that they can impart.
2. The etiology of under-eye circles is multifactorial and includes periorbital volume loss and skin laxity, fat orbital prolapses, increased prominence and density of subcutaneous vasculature, and excessive dark skin pigments
3. The ease of use, the minimal incidence of complications, and the lack of downtime associated with hyaluronic acid fillers make these products nearly ideal for treating under-eyes volume loss.
4. Long-pulsed lasers target lower eyelid blood vessels; Q-switched lasers and fractionated resurfacing treat dark skin pigment. Skin laxity and wrinkles can be treated fractionated CO2 laser.