With the rest of the Beauty Brains taking a break to work on their book, I thought this would be a good time for guest blogger Dr. Brett Kotlus to teach us about dark circles. Take it away Dr. Brett:
During consultations in my cosmetic surgery practice, patients commonly ask about dark circles under their eyes. Some have been asked by friends if they have a black eye, and others hear comments about how they look tired. I hear many stories about people who have tried all sorts of store-bought treatments and home remedies. The problem with each of these individual “fixes” is that there is a long list of reasons why the dark circles appear, each requiring different approaches for improvement. There is no single “magic bullet” for all under-eye circles, and I am wary of any product that claims to universally remove them.
What causes the dark circles?
Thin skin: Interestingly, the eyelid skin is the thinnest in the body, sometimes only several cells thick! In those with extremely thin skin, the underlying muscle (orbicularis oculi) and/or blood vessels may become visible. This muscle is composed of reddish, circular fibers that be seen through the skin as a blue to purple area. This skin may become thinner with age, dehydration, and with long-term use of topical retinoids to name a few causes. Remedies in this situation include the use of concealers, maintaining body and skin hydration by drinking plenty of water and using moisturizers, and skin thickening therapies.
Dark shadows: Sometimes those dark circles are illusions caused by shadowing. In people with extra skin, bulging fat, excess fluid retention, or under-eye hollowing, lighting from above will cast shadows under the eyes. The way to fix this is by correcting the underlying cause of fluid retention (sleeping with your head elevated can help), adding fillers or fat grafting to eliminate hollow grooves, skin tighteningsuch as resurfacing procedures, and lower blepharoplasty, to remove or reposition fat pouches.
Blood vessels: The eyelids have a rich blood supply by way of many vessels found under the skin. Prominent, dilated, or superficially located vessels, or blood pooling in networks of veins can sometimes be seen through thin skin, and this blood may be apparent as dark areas or lines. Again, concealers may disguise this problem. Surgical closure of these vessels, sclerotherapy, and laser treatment are more definitive options, but may be somewhat riskier.
Skin pigmentation: An accumulation of pigment in the eyelid skin (melanocytosis) is another cause of dark circles. This pigment can be present at birth or develop later in life. Others develop hyperpigmentation after episodes of inflammation or allergy, the so-called “post inflammatory hyperpigmentation”. It can also be related to medications such as glaucoma drops and oral estrogens. Sun exposure can also worsen patches of facial pigment, sometimes called “melasma”. The first step in treatment is identifying any offending agents and eliminating them. Other steps include topical depigmenting agents, Q-switched lasers, intense pulsed light, and fractional photothermolysis.
What should you do?
The first step in treating those annoying dark circles is identifying the problem. The best way to do this is by enlisting the help of a doctor who has special training in this area, such as an oculofacial plastic surgeon or a dermatologist. They can suggest a skin care regimen that might include hydroquinone (a skin-lightener), a moisturizer, and a sunscreen. If a surgical option such as blepharoplasty or laser treatment is appropriate, ask them about their specific training in that procedure and how many they have performed. Most importantly, be suspicious of products and infomercials that claim to eliminate all dark lines because you now know it can be a complicated problem requiring a complicated solution, like many things in life.
Brett S. Kotlus, M.D., M.S. is a cosmetic and oculofacial plastic surgeon at Allure Medical Spa in Michigan. He can be contacted at firstname.lastname@example.org