Posted on February 29, 2016
Ah, the dark circles. The ever present question, “Are you tired?”
What can you do about dark circles?
As with all things, first you need to figure out the problem of the darkness. Some things can be improved, some cannot.
- SHADOW. This is a common cause. Do you have excess skin on the lower eyelid or bulging of the fat under the eye? Many times the “bulge” of the eyelid fat is really an issue of the cheek. As we age we lose cheek fat, and the cheek becomes flat. Many women notice the eyelid fat bulge, so they think the eyelid is the issue – but their cheek is the issue. This gives the illusion of a long lower eyelid, where the tear trough is farther onto the cheek which makes you look old and tired. Again, it is important to identify the culprit. If it is eyelid, fix the eyelid. If the issue is cheek, fix the cheek. You do NOT want to hollow out the lower eyelid (some people think you want to totally get rid of the under eye fat. This gets rid of the bulge, but leaves people looking older and hollow). Look at any child- their face is full.
- Shadow from hollow can frequently be improved by injecting a filler in the cheek area, which can tighten the skin (a little bit) and fill the hollows. This changes the way light bounces off the cheek and gets rid of the shadow. Hyaluronic acid fillers like Juvederm or Restylane are great for this. This is a simple in office procedure, 1/2 hour, no downtime (unless you bruise). Stop anything which increases bruising 2 weeks prior.
- Surgery also improves this by
- 1. tightening the skin (see blepharoplasty)
- 2. redraping the fat (I tend to remove very little lower eyelid fat if any at all- see blepharoplasty) and
- 3. fat transfer to the cheek to fill in the hollow.
- Surgery recovery is 1-2 weeks. The surgery is local anesthesia with twilight.
- PIGMENT. Some people have pigmentation of the actual skin under the eye. You can pull the eyelid skin tight and look at it under a light. Does the skin look darker than the surrounding skin?
- If this is the issue, then you can try skin lightening creams (like hydroquinone and retin A- don’t get them in the eye), but I have found these frequently don’t do much, but likely worth a try. They take months to work when they do work. You can also try to peel or laser the area to lighten it. Again, these vary in their effectiveness. If you have darker skin in general, be careful doing lasers or peels. These treatments can cause pigmentation in certain skin types.
- Eyelid surgery can help even if the pigment stays. If you have skin bunching on itself, it makes the pigment look darker. You can see this by pulling the skin tight, and see how the darkness seems to lighten.
- THIN SKIN. The eyelid skin is thin to begin with, and as you age thins. Sometimes the pigment is you are actually seeing the underlying vessels and tissue. Peels may help a little with this, but this is a harder one to fix.
As with all things, this is a good reason to see a surgeon for an evaluation to help you figure out what is what. I have the Vectra 3D imaging system. On it there is a filter which shows pigmentation and sun damage. It is great to get a baseline of this, so as you do treatments you can have a more objective measure of its effectiveness.